Form FDE-653-023 Funeral Establishment Prearrangement Registration Renewal Application - Washington

Form FDE-653-023 or the "Funeral Establishment Prearrangement Registration Renewal Application" is a form issued by the Washington State Department of Licensing.

The form was last revised in February 1, 2019 and is available for digital filing. Download an up-to-date Form FDE-653-023 in PDF-format down below or look it up on the Washington State Department of Licensing Forms website.

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Funeral Establishment
Prearrangement Registration
Renewal Application
Use this form to apply for a renewal of your Funeral Establishment
Prearrangement Registration License.
Send this completed form and the $225 renewal fee in check or money
order payable to the Department of Licensing to:
For validation only 001-070-299-0010
Funeral and Cemetery Licensing
Department of Licensing
PO Box 35001
Seattle, WA 98124-3401
Applicant information
TYPE OR PRINT Name of establishment or branch
License number
UBI number
Mailing address
City
State
ZIP code
(Area code) Telephone number
Email
Licensed funeral director name
The information I have provided is true and correct.
X
When you have completed this form, print it out and sign here.
Signature
Date
FDE-653-023 (R/2/19)WA
Click here to START or CLEAR, then hit the TAB button
Funeral Establishment
Prearrangement Registration
Renewal Application
Use this form to apply for a renewal of your Funeral Establishment
Prearrangement Registration License.
Send this completed form and the $225 renewal fee in check or money
order payable to the Department of Licensing to:
For validation only 001-070-299-0010
Funeral and Cemetery Licensing
Department of Licensing
PO Box 35001
Seattle, WA 98124-3401
Applicant information
TYPE OR PRINT Name of establishment or branch
License number
UBI number
Mailing address
City
State
ZIP code
(Area code) Telephone number
Email
Licensed funeral director name
The information I have provided is true and correct.
X
When you have completed this form, print it out and sign here.
Signature
Date
FDE-653-023 (R/2/19)WA
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