Texas Funeral Service Commission Crematory Application Form (Page 2 of 5) in pdf

Texas Funeral Service Commission

Crematory Application

Name of Crematory _____________________________________________________________

Physical Address________________________________________________________________

(street)

(city)

(zip)

Mailing address (if different from above) ____________________________________________

______________________________________________________________________________

Email ________________________________________________________________________

Telephone Number ________________________

Fax Number___________________

Is this crematory on tax exempt property?

Yes________ No ________

Is this crematory on/adjacent to a perpetual care cemetery?

Yes________ No ________

Name of Cemetery _______________________________________________________

Is this crematory on/adjacent to a funeral establishment?

Yes________ No ________

Name of Funeral Establishment ______________________ License # ______________

Is this crematory on/adjacent to a commercial embalming facility? Yes________ No ________

Name of commercial embalming facility _______________ License # ______________

Please check all that apply:

New Establishment



Name Change *



Ownership Change *



Physical Location Change *



* Provide the name and license number of existing establishment for changes starred above:

______________________________________________________________________________

Is there a crematory in the service area, county or city that bears a similar name?



Yes – Name:__________________________________________________________



EMPLOYEE LISTING

Certified personnel employed and active in this crematory (attach additional sheet if necessary):

Name________________________________ Certification #_____________________

Non-certified personnel actively employed in this crematory (attach additional sheet if

necessary): ____________________________________________________________________

______________________________________________________________________________

Texas Funeral Service Commission Crematory Application Form Page 2