21 NCAC 34B .0510          COURTESY CARD RENEWAL FORM

Applications for annual renewal of a courtesy card shall be made on forms available on the Board's website at ncbfs.org. All renewal applications for a courtesy card shall contain the following:

(1)           The applicant's full name, date of birth, place of birth, sex, and social security number;

(2)           The applicant's email address, residential address, mailing address, and phone number(s);

(3)           The name and address of the applicant's current employer;

(4)           Whether the applicant is applying for a funeral service, a funeral director, or embalmer courtesy card;

(5)           Whether the applicant currently holds a funeral service license, funeral director license, or embalmer license in any jurisdiction outside of North Carolina and if so, the name of the jurisdiction, the date that the license was issued, the license number, and the expiration date of the license;

(6)           Whether the applicant has been denied a credential in another state and, if so, the jurisdiction and the reason for the denial of the credential;

(7)           Whether the applicant has been convicted of a felony or misdemeanor crime since the last renewal and, if so, a statement providing the jurisdiction, charge, date of disposition, and sentence imposed of each conviction;

(8)           Whether the applicant has any criminal charges currently pending and, if so, the nature of the charge and the jurisdiction in which the charge is pending;

(9)           Whether the applicant has had an occupational or business license suspended or revoked by any local, state, or federal agency since the last renewal and, if so, a statement providing the reason for the action and the date, location, and circumstances of any violation that led to action against the license;

(10)         Whether any court, board, agency, or professional organization has found the applicant guilty of misconduct, unprofessional conduct, dishonest or fraudulent practice, or incompetent practice since the last renewal and, if so, the tribunal and the date of the finding;

(11)         Whether the applicant has any charges pending before any court, board, agency, or professional organization for unprofessional conduct, dishonest or fraudulent practice, or incompetent practice and, if so, the tribunal in which the charge is pending;

(12)         Whether, since the last renewal, the applicant has been the subject of any investigation for employee misclassification and, if so, the results of the investigation;

(13)         The applicant's notarized signature to certify that:

(A)          he or she has prepared and read the application;

(B)          the information provided in the application is true;

(C)          the applicant has read and understands the public notice statement on employee misclassification that is set forth in the application and has disclosed any investigations for employee misclassification, and its results, over the preceding two year period, as prescribed by G.S. 143-789; and

(D)          he or she understands that any credential issued shall be governed by the provisions of Article 13A, Chapter 90 of the North Carolina General Statutes and the rules promulgated by the Board.

(14)         The application fee, as prescribed by G.S. 90-210.28 and 21 NCAC 34A .0201. If the application fee is dishonored by the licensee's drawee bank for any reason, the Board shall suspend the license until the renewal fees and non-sufficient fund charges are paid.

History Note:        Authority G.S. 90‑210.23(a); 90‑210.25(b)(3); 143-789;

Eff. February 1, 1976;

Readopted Eff. September 27, 1977;

Amended Eff. November 1, 2004; September 1, 1979;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. August 19, 2017;

Amended Eff. February 1, 2026.