Dear Applicant: Thank you for your interest in acquiring a Cinerator Facility License. Enclosed is an application for the Cinerator Facility. Please be advised, you will also need the following information as supporting documentation. 1. Complete the Business Entity-List of Principals Form located on our website, www.myfloridacfo.com/funeralcemetery. 2. Fingerprint card submissions for each officer, owner, manager and/or director. You must make the payment for processing at www.ibtfingerprint.com/state/?st=fl. If you are in the state of Florida, please follow the prompts on the website to locate a site to have the fingerprints taken electronically. If you are outside the state of Florida, or unable to find a location in your area, you will need to follow the directions at the aforementioned website in order to pay for the processing and have the fingerprint cards sent to you. F.S. 497.142(11)(a) When an applicant is required by this chapter to submit fingerprints in applying for a license, the following persons shall be required to submit such fingerprints: 1. Where the applicant is a natural person, the fingerprints of the natural person making application. 2. Where the applicant is a corporation, the fingerprints of the persons serving in the following capacities: chief executive officer and president, or both persons if the positions are filled by different persons; chief financial officer; chief of operations; general counsel if a corporation employee; and members of the board. 3. Where the applicant is a limited liability company, the fingerprints of all managers and members of the limited liability company. 4. Where the applicant is a partnership, the fingerprints of all partners. (b) In addition to persons identified in paragraph (a) as being required to provide fingerprints, the department may, during its prelicensing investigation of the applicant pursuant to subsection (3), on a case-by-case basis, require fingerprints from any other employee of the applicant if the department has grounds to believe FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF FUNERAL, CEMETERY AND CONSUMER SERVICES 200 EAST GAINES STREET TALLAHASSEE, FLORIDA 32399-0361 TEL. 850-413-3039 FAX 850-413-4958 SC 293-3039 WWW.MYFLORIDACFO.COM/FUNERALCEMETERY Affirmative Action Equal Opportunity Employer that any such employee may have committed any crime and that such employee’s relationship to the applicant may render the applicant a danger to the public if the license applied for is issued. 3. If the Cinerator Facility will be contracting any services out (i.e. embalming, refrigeration, storage or transportation of bodies), a copy of the contract must be submitted. It must include the Name of the Establishment, License Number, Address and be signed by the Funeral Director in Charge or Owner. 4. Complete the Elections of Procedures for Removal of Cremated Remains Form located on our website, www.myfloridacfo.com/funeralcemetery 5. If the facility is a Corporation or LLC or has a Fictitious Name, such names must be filed with the Department of State (www.sunbiz.org) and a copy of the certificate must be submitted with the application. 6. All operational personnel must also take a two hour communicable disease course. Please note the following rule: 69K-17.0035 Communicable Disease Education Required for Operational Personnel. (1) All operational personnel as defined in Rule 69K-15.005, F.A.C., shall successfully complete one Board approved course on communicable diseases, within 10 days after the date they are employed by any entity that is subject to Chapter 497, F.S. The course shall be at least two (2) hours and may include the use of approved video-cassette courses, or other types of audio, video, Internet, or home study courses. All persons subject to this rule shall maintain a certificate of completion showing proof of meeting the communicable disease education requirement as a condition of employment with any establishment, facility or service regulated under Chapter 497, F.S. (2) Courses approved for two (2) or more hours pursuant to paragraph 69K-17.0042(3)(c), F.A.C., can be used to fulfill the two (2) hour communicable disease educational requirement. The name, address, telephone number and email address for approved continuing education providers that offer courses that will satisfy this communicable disease educational requirement can be found on the Department’s website (http://www.myfloridacfo.com/FuneralCemetery). Rulemaking Authority 497.103(1)(s), (5)(a), 497.162 FS. Law Implemented 497.162 FS. History–New 4-10-94, Amended 9-10-96, 11-20-96, 6-24-01, Formerly 61G8-17.0035, Amended 6-9-09. 7. Please note the following rule: 69K-22.002 Inspection. Each cinerator facility shall be inspected prior to the issuance and renewal of its license and FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF FUNERAL, CEMETERY AND CONSUMER SERVICES 200 EAST GAINES STREET TALLAHASSEE, FLORIDA 32399-0361 TEL. 850-413-3039 FAX 850-413-4958 SC 293-3039 WWW.MYFLORIDACFO.COM/FUNERALCEMETERY Affirmative Action Equal Opportunity Employer shall meet the following criteria: (1) Maintain one or more retorts for the reduction of dead human bodies. (2) Maintain refrigeration which satisfies the standards set by the Department of Health and which contains a sufficient number of shelves for the average daily number of bodies stored, if unembalmed bodies are kept at the site. (3) Maintain sufficient pollution control equipment to comply with the Department of Environmental Protection requirements in order to secure annual approved certification. (4) Either have on site or immediately available sufficient gasketed metal containers of a type required for the transportation of bodies as specified in Rule 10D-37.012, F.A.C. (5) Maintain the premises in a clean and sanitary condition. (6) Have appropriate Department of Environmental Protection permits. (7) All signed contracts are to be retained for a period of at least two years. If you have any further questions, please feel free to contact the Division of Funeral, Cemetery and Consumer Services at 850-413-3039. FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF FUNERAL, CEMETERY AND CONSUMER SERVICES 200 EAST GAINES STREET TALLAHASSEE, FLORIDA 32399-0361 TEL. 850-413-3039 FAX 850-413-4958 SC 293-3039 WWW.MYFLORIDACFO.COM/FUNERALCEMETERY Affirmative Action Equal Opportunity Employer