detailed license verification - michigan · detailed license verification authority: r 339.301...
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DETAILED LICENSE VERIFICATION AUTHORITY: R 339.301 & 1979 PA 152
PENALTY: FAILURE TO PROVIDE THIS INFORMATION MAY RESULT IN DENIAL OF THE APPLICATION AND/OR DISCIPLINARY ACTION.
Name License Number
Phone Number E-Mail Address
Name and Address to Mail License Verification
LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals withdisabilities.
Mortuary Science - Funeral Director/Trainee
Mortuary Science - Funeral Homes
Mortuary Science - Courtesy License
FEE PAYMENT INFORMATION - $15.00 for each request. Please submit a separate form for each request.
LICENSE TYPE
For Funeral Home: Please Check Box for Information Requested
Other
Make your check or money order in U.S. Currency payable to:
STATE OF MICHIGAN
FOR OFFICE USE ONLY
4503-51
4502-51
4501-51
FEES ARE AUTHORIZED UNDER 1979 PA 152 & R339.301 AND ARE NOT REFUNDABLE.
Approved By: Date Approved:
License Number
CSCL/LCE-801 (10/19) Page 1 of 1
Corporations, Securities & Commercial Licensing Licensing Division
P.O. Box 30018, Lansing, MI 48909517-241-9221
www.michigan.gov/mortuaryscience
Business Owner Opening & Closing Dates