Form DFS-N1-1754 "Centralized Embalming Facility - Monthly Report of Cases Embalmed and Bodies Handled" - Florida

What Is Form DFS-N1-1754?

This is a legal form that was released by the Florida Department of Financial Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2006;
  • The latest edition provided by the Florida Department of Financial Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DFS-N1-1754 by clicking the link below or browse more documents and templates provided by the Florida Department of Financial Services.

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Download Form DFS-N1-1754 "Centralized Embalming Facility - Monthly Report of Cases Embalmed and Bodies Handled" - Florida

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C
E
F
-- M
R
C
E
B
H
ENTRALIZED
MBALMING
ACILITY
ONTHLY
EPORT OF
ASES
MBALMED AND
ODIES
ANDLED
Mail to: Division of Funeral, Cemetery & Consumer Services, Attn: Monthly Reports, Larson Building, 200 E. Gaines Street, Tallahassee FL 32399
Name of centralized embalming facility:
License #:
Phone #: (
)
-
This report is for
Month:
Year:
Name of deceased
Date received
Date of death
Date embalmed
Name of embalmer
Method of disposal
County of death
Burial transit permit #
mm/dd/yy
mm/dd/yy
mm/dd/yy
TOTAL BODIES REPORTED:
We the undersigned depose and say that we personally supervised the cases indicated above. Embalming was accomplished by arterial and/or cavity injection of a standard embalming fluid in
accordance with: rule 61K, Florida Administrative Code (or successor rules), and Part III of Chapter 497, Florida Statutes.
Signature of embalmer & License #
Signature of embalmer & License #
Signature of embalmer in charge:
Signature of embalmer & License #
Signature of embalmer & License #
License number of embalmer in charge:
Signature of embalmer & License #
Signature of embalmer & License #
Date signed
Page
of
/
/
DFS-N1-1754 “Centralized Embalming Facility – Monthly Report of Cases Embalmed and Bodies Handled,”
Rev. 10/06
C
E
F
-- M
R
C
E
B
H
ENTRALIZED
MBALMING
ACILITY
ONTHLY
EPORT OF
ASES
MBALMED AND
ODIES
ANDLED
Mail to: Division of Funeral, Cemetery & Consumer Services, Attn: Monthly Reports, Larson Building, 200 E. Gaines Street, Tallahassee FL 32399
Name of centralized embalming facility:
License #:
Phone #: (
)
-
This report is for
Month:
Year:
Name of deceased
Date received
Date of death
Date embalmed
Name of embalmer
Method of disposal
County of death
Burial transit permit #
mm/dd/yy
mm/dd/yy
mm/dd/yy
TOTAL BODIES REPORTED:
We the undersigned depose and say that we personally supervised the cases indicated above. Embalming was accomplished by arterial and/or cavity injection of a standard embalming fluid in
accordance with: rule 61K, Florida Administrative Code (or successor rules), and Part III of Chapter 497, Florida Statutes.
Signature of embalmer & License #
Signature of embalmer & License #
Signature of embalmer in charge:
Signature of embalmer & License #
Signature of embalmer & License #
License number of embalmer in charge:
Signature of embalmer & License #
Signature of embalmer & License #
Date signed
Page
of
/
/
DFS-N1-1754 “Centralized Embalming Facility – Monthly Report of Cases Embalmed and Bodies Handled,”
Rev. 10/06