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Applications/Forms

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Applications and Forms

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Compliance Guide
NOTICE FOR APPLICANTS AND LICENSEES
Please note that the NC Board of Funeral Service has discontinued all FAX service and now relies upon digital transmission of documents through email or a mail delivery service. Some application forms and other documents on this page still show a FAX number. We are in the process of revising application forms and other documents to remove any reference to a FAX number.

License/Permit Renewals

Applications

Chapel Renewal Application (fillable BFS 57(r))
Courtesy Card Renewal Application (fillable BFS 37(r))
Crematory Establishment Renewal Application (fillable BFS 52(r))
Crematory Manager Permit Renewal Application (fillable BFS 51(r))
Funeral Establishment Renewal Application (fillable BFS 17(r))
Hydrolysis Licensee Renewal Application (fillable BFS 54(r))
Hydrolysis Manager Renewal Application (fillable BFS 53(r))
Individual License Renewal Application (fillable BFS 12(r))
Preneed Funeral Establishment Renewal Application (fillable BFS PN-3(r) / PN-3A)
Provisional License Renewal Application (fillable BFS-12(b))
Removal and Transportation Permit Renewal Application (fillable BFS 60(r))
Unaffiliated Practice Permit Renewal Application (fillable BFS 61(r))

Establishment/Unaffiliated/Chapel

New Establishment

New Funeral Establishment Application Check-List
Application for Funeral Establishment Permit (fillable BFS-17(a))

Location Change

Application for Change of Location of Funeral Establishment

Unaffiliated

New Unaffiliated Permit Application Check-List
Application for Unaffiliated Practice Permit (fillable BFS-61(a))

Chapel

New Chapel Application Check-List
Application for Chapel Permit (fillable – BFS-57(a))

Waiver – Practicing during Disasters

Request for Temporary Waiver of Funeral Establishment Permit Requirements During Declared State of Emergency (Per 21 NCAC 34B .0617)

Waiver – Practicing during Emergencies

Request for Temporary Waiver of Funeral Establishment Permit Requirements During Emergency Occurrence (Per 21 NCAC 34B .0618)

Preneed

Applications

New Preneed Funeral Establishment Check-List
New Preneed Funeral Establishment Application
Preneed Funeral Establishment License Bond
Schedule A Form – Application for Individual Preneed Sales License
Contract to Share Individual Preneed Sales Licensees

Insurance Funded Preneed Funeral Contracts

Standard Insurance Preneed Funeral Contract & SGSS
Inflation-Proof Insurance Preneed Funeral Contract & SGSS

TRUST FUNDED PRENEED FUNERAL CONTRACTS

Standard Trust Preneed Funeral Contract & SGSS
Inflation-Proof Trust Preneed Funeral Contract & SGSS

CERTIFICATE OF PERFORMANCE

Certificate of Performance ("COP") (9/2019)
COP – Inflation-Proof Calculator (3/2024)
COP – IP Calculator Instructions

REQUEST FOR BOARD TO PROVIDE COPY OF PRENEED CONTRACT

Request for Copy or Copies of Preneed Contract Documents

MISCELLANEOUS FORMS AND SAMPLE LETTERS

Individual Preneed File Check-List
Use this form to ensure each preneed funeral contract file contains those items subject to examination by Board inspectors.
Form PN-4 Substitution of Financial Instition Form
Note: This form is to be used when a preneed funeral establishment wishes to transfer its own preneed funeral trust accounts from one financial institution to another. It is not used when a purchaser wishes to transfer his or her trust funded preneed funeral contract from one preneed funeral establishment to another.
Form PN-6 Cash Receipt Journal
Insurance Company Request – Policy Owner Release of Information
Insurance Company Request – Funeral Home Requests Year End Policy Status Information
Procedures for Amending Previously Filed Preneed Funeral Contracts
Procedures for Revoking an Irrevocable Preneed Funeral Contract

Cremation

CREMATORY LICENSEE APPLICATIONS

New Crematory Licensee Application Check-List
Application for Crematory Licensee Permit
Application for Crematory Manager Permit

AUTHORIZATIONS AND WAIVER OF 24 HOUR WAITING PERIOD

Model – Standard Cremation Authorization Form
Medical Examiner’s Authorization for Cremation Form
Form 56E1 – Authorization for Cremation of Amputated Body Parts
Form 56F1 – Confirmation of Fetal Death for Cremation
Form 55A – Waiver of Waiting Period for Cremation

RECORDS OF RECEIPT AND DELIVERY

Form 56G1 – Consolidated Receipts (56 A1,B1, & C1) (9/2019)
Form 56A1 – Receipt of Human Remains by Crematory Licensee (9/2019)
Form 56B1 – Record of Cremation by Crematory Licensee (9/2019)
Form 56C1 – Delivery of Cremated Remains from Crematory Licensee (9/2019)
Form 56D1 – Delivery of Cremated Remains from Funeral Provider (9/2019)

MONTHLY REPORT

Model – Monthly Cremation Report

CREMATION FILE CHECK-LIST

Individual Cremation File Check-List
Use this form to ensure each cremation file contains those items subject to examination by Board inspectors.

Embalming Facilities

New Embalming Facility Application Check-List
Application for Embalming Facility Permit

Miscellaneous

NCBFS REQUEST FOR DECLARATORY RULING

Form DR-1 – Request for Declaratory Ruling

NCBFS PUBLIC RECORDS REQUEST

Request for Review of Public Records

OCME – AUTHORIZATION FOR RELEASE OF REMAINS

Form OCME 0082 – Authorization for Release of Remains

Individual Licenses

Applications

Application for Courtesy Card (fillable BFS-37(a))
Application for Individual License (fillable BFS-12(a))
Application for Reciprocal Licensure (fillable BFS-34)
Verification of Licensure for Reciprocal Application (fillable)
Application for Removal and Transportation Permit (fillable BFS-60(a))
Application for Active Military Status (fillable)
Provisional License Application (fillable BFS-12(b))

Applicants for licensure as a funeral director, funeral service licensee, or embalmer may register for the required examinations by completing the documents listed under “Exam Registration”.

Applicant Information

Use of Criminal History Records
Predetermination Form

Exam Registration

National Board Examination
North Carolina Pathology Examination

Continuing Education

Instructions

Instructions: Continuing Education

Guidelines

Continuing Education Content Guidelines

Applications

Application for Continuing Education Provider Approval (BFS CE-1)
Application for Course Approval (BFS CE-2)
Application for Instructor Approval (BFS CE-3)

Reports

Continuing Education Class Report (BFS CE-4)
Continuing Education Program Schedule Submission Form (BFS CE-5 / BFS CE-5A)

Traineeship

Applications

Application for Registration as Resident Trainee in Funeral Directing (BFS-7)
Application for Registration as Resident Trainee in Embalming (BFS-8)
Application for Registration as Resident Trainee in Funeral Service (BFS-9)

New Work Reports

Resident Trainee Work Report – Funeral Directing (BFS-27-FD)
Resident Trainee Work Report – Embalming (BFS-27-EM)
Resident Trainee Work Report – Funeral Service (BFS-27-FS)

Work Reports and Checklists

Resident Trainee Work Report – Funeral Directing (BFS-27-FD)
Resident Trainee Work Report – Funeral Directing (Reference Guide)
Resident Trainee Work Report – Embalming (BFS-27-EM)
Resident Trainee Work Report – Embalming (Reference Guide)
Resident Trainee Work Report – Funeral Service (BFS-27-FS)
Resident Trainee Work Report – Funeral Service (Reference Guide)
Resident Trainee Funeral Directing Checklist
Resident Trainee Embalming Checklist

Affidavits

Affidavit of Competency for Resident Traineeship Funeral Directing
Affidavit of Competency for Resident Traineeship Embalming
Affidavit of Competency for Resident Traineeship Funeral Service
Affidavit to Certify Resident Traineeship – Funeral Directing (BFS-10B)
Affidavit to Certify Resident Traineeship – Embalming (BFS-10C)
Affidavit to Certify Resident Traineeship – Funeral Service (BFS-10A)

Employment Supervision

Change in Employment for Resident Traineeship (BFS-11)
Trainee and Trainee Supervisor Verification
Approved Activities for Resident Trainees

Alkaline Hydrolysis

HYDROLYSIS LICENSEE APPLICATIONS

New Hydrolysis Licensee Check-List
Application for New Hydrolysis Licensee Application
Application for Hydrolysis Manager Permit

AUTHORIZATIONS AND WAIVER OF 24 HOUR WAITING PERIOD

Model – Standard Alkaline Hydrolysis Authorization Form
Medical Examiner’s Authorization for Cremation
Note: G.S. § 130A-388 and 10A NCAC 44 .0501 prohibit any decedent from being cremated or hydrolyzed until a medical examiner has granted permission to do so. For cremation, those death’s certified by an attending physician, Form DHHS 1881 could be required. Currently, there is no Form DHHS 1881 equivilant specifically designated for the purpose of authorizing hydrolysis. Until which time such form is available, it is Board staff’s opinion that a funeral provider or hydrolysis licensee would be in compliance with G.S. § 130A-388 and 10 NCAC 44 .0501 to utilize Form DHHS 1181 for the purpose of obtaining a medical examiner’s permission to hydrolyze human remains.
Form 56E2 – Authorization for Alkaline Hydrolysis of Amputated Body Parts
Form BFS 56F2 – Confirmation of Fetal Death for Alkaline Hydrolysis
Form 55B – Waiver of Waiting Period for Alkaline Hydrolysis

RECORDS OF RECEIPT AND DELIVERY

Form 56G2 – Consolidated Receipts (56 A2, B2, & C2) (9/2019)
Form 56A2 – Receipt of Human Remains by Hydrolysis Licensee (9/2019)
Form 56B2 – Record of Alkaine Hydrolysis by Hydrolysis Licensee (9/2019)
Form 56C2 – Delivery of Hydrolyzed Remains from Hydrolysis Licensee (9/2019)
Form 56D2 – Delivery of Hydrolyzed Remains from Funeral Provider (9/2019)

MONTHLY REPORT

Model – Monthly Alkaline Hydrolysis Report

HYDROLYSIS FILE CHECK-LIST

Individual Hydrolysis File Check-List
Use this form to ensure each hydrolysis file contains those items subject to examination by Board inspectors.

Mutual Burial Associations

MBA Annual Report Form
MBA Certificates of Credit – Accepting Funeral Establishments
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