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The Georgia C 15 form serves as an essential reporting tool for funeral homes and registrants involved in preneed funeral contracts. This form is designed to provide a comprehensive overview of all unserviced preneed funeral contracts as of December 31st of the reporting year. It is mandated by O.C.G.A. 10-14-12(g) and requires the submission of detailed information about each contract holder, including names, contract dates, total amounts, and bank account details. The form is divided into several sections, beginning with general information about the funeral home and its registration number. Following that, the heart of the form focuses on the uns serviced contracts, where registrants must itemize each contract along with its pertinent financial details. Finally, the certification section holds the signatory accountable, affirming that all information provided is accurate and that necessary deposits have been made to the preneed escrow account. Completing this form accurately is crucial for compliance and maintaining transparency in the funeral service industry.

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STATE OF GEORGIA

 

 

 

Brian P. Kemp

 

SECURITIES AND BUSINESS REGULATION

 

Robert D. Terry

 

Secretary of State

 

 

2 Martin Luther King Jr. Drive, S.E.

 

Division Director

 

 

 

 

 

Suite 802 West Tower

 

 

 

 

 

 

 

Atlanta, Georgia 30334

 

 

 

 

 

 

 

(404) 656-3920

 

 

 

 

 

REPORT AND ITEMIZED LIST OF ALL UNSERVICED PRENEED FUNERAL CONTRACTS

 

 

 

 

 

 

 

AS OF 12/31/200__

 

 

 

This report is mandated by O.C.G.A. 10-14-12(g).

 

 

 

 

 

Please read instructions accompanying this form.

 

 

 

 

 

PART 1 - GENERAL

 

 

 

Registration Number

 

 

Total number of unserviced

 

Phone Number

 

 

 

 

 

contracts as of 12-31-200__

 

 

 

 

Name of Registrant/Funeral Home

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address

 

 

 

 

 

 

City

State

Zip Code

 

 

 

 

 

 

 

 

 

 

Location of Records

 

 

 

 

 

 

City

State

Zip Code

 

 

 

 

 

 

 

 

Name and phone number of contact person regarding this report:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART II - UNSERVICED PRENEED FUNERAL CONTRACTS

 

 

 

 

 

 

 

 

 

 

 

 

Contract Holder Name and

Depository

 

Date of

 

Contract

Total Amount

Amount

Total Amount

 

Bank Account Number

 

 

Contract

 

Number

of Contract

Paid to Date

on Deposit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL (Page 1)

 

 

 

 

 

 

 

 

 

TOTAL (Page 2)

 

 

 

 

 

 

 

 

 

TOTAL OF ALL PAGES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attach additional pages, as necessary, with complete information as above on every contract holder.

Form C-15 Jan 2010

page 1

PART II - UNSERVICED PRENEED FUNERAL CONTRACTS

Contract Holder Name and

Depository

Date of

Contract

Total Amount

 

Amount

Total Amount

Bank Account Number

 

Contract

Number

of Contract

 

Paid to Date

on Deposit

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL (Page 2)

 

 

 

 

 

 

 

Attach additional pages, as necessary, with complete information as above on every contract holder.

 

 

 

 

PART III - CERTIFICATION

 

 

 

 

 

 

 

 

 

 

I hereby certify, under penalties of perjury, that the information contained in this Annual Report and the supporting documents attached hereto are true and correct to the best of my knowledge and belief. I further certify that all required deposits have been made

to the preneed escrow account. I am authorized to sign this document on behalf of the individual or corporate owner.

Signature:

Print Name:

 

 

Title

Date

 

 

Form C-15 Jan 2010

page 2

Form Specifications

Fact Name Details
Governing Law This form is mandated by the Official Code of Georgia Annotated (O.C.G.A.) § 10-14-12(g).
Purpose of the Form The Georgia C-15 form is used to report and itemize all unserviced preneed funeral contracts as of December 31st of the reporting year.
Filing Frequency This report must be filed annually, specifically by the end of each calendar year.
Contact Information The form requires the registrant to provide a contact person’s name and phone number for inquiries regarding the report.
Certification Requirement Signatures are required, certifying that all information is true and that all necessary deposits have been made to the preneed escrow account.

Georgia C 15: Usage Guidelines

The Georgia C 15 form is a report that must be completed to provide an itemized list of all unserviced preneed funeral contracts as of December 31 of a given year. Following the steps below will ensure that the form is filled out correctly and submitted in a timely manner.

  1. Obtain the Georgia C 15 form from the Georgia Secretary of State's website or your local office.
  2. Fill in the Registration Number at the top of the form.
  3. Indicate the Total number of unserviced contracts as of December 31 of the reporting year.
  4. Provide the Name of Registrant/Funeral Home.
  5. Enter the Mailing Address, including City, State, and Zip Code.
  6. List the Location of Records, including City, State, and Zip Code.
  7. Provide the Name and phone number of the contact person regarding this report.
  8. In Part II, begin listing the Contract Holder Name and Depository for each unserviced preneed funeral contract.
  9. For each contract, enter the Date of Contract, Total Amount, Amount Paid to Date, Bank Account Number, and Contract Number.
  10. Calculate the TOTAL for each page and ensure it is recorded accurately.
  11. If there are more contracts than can fit on the form, attach additional pages with the same information for each contract holder.
  12. In Part III, read the certification statement carefully.
  13. Sign the form, print your name, include your title, and date the document.

Your Questions, Answered

What is the purpose of the Georgia C 15 form?

The Georgia C 15 form serves as a report and itemized list of all unserviced preneed funeral contracts as of December 31st of the specified year. This report is required by Georgia law, specifically O.C.G.A. 10-14-12(g), to ensure transparency and accountability in the management of preneed funeral contracts. It helps regulatory authorities monitor compliance and protect consumers who have made advance arrangements for funeral services.

Who is required to file the Georgia C 15 form?

Funeral homes and registrants that offer preneed funeral contracts must file the Georgia C 15 form. This includes any entity that has entered into agreements with clients for funeral services to be provided in the future. It is essential for these entities to keep accurate records and submit the form annually to remain compliant with state regulations.

What information is required on the form?

The form requires several key pieces of information. Registrants must provide their registration number, the total number of unserviced contracts, and their contact information. Additionally, for each preneed funeral contract, details such as the contract holder's name, depository, date of contract, total amount, amount paid to date, and bank account number must be included. If there are more contracts than can fit on the form, additional pages may be attached with complete information.

When is the Georgia C 15 form due?

The Georgia C 15 form must be submitted annually, with the reporting date set as December 31st of the previous year. It is crucial for registrants to be aware of this deadline to avoid potential penalties or compliance issues. Timely submission ensures that all records are up-to-date and accurately reflect the status of preneed funeral contracts.

What happens if a funeral home fails to file the form?

If a funeral home does not file the Georgia C 15 form by the deadline, it may face legal consequences, including fines or other penalties. Additionally, failure to comply can lead to increased scrutiny from regulatory authorities and may jeopardize the funeral home’s ability to operate or offer preneed contracts in the future. Maintaining compliance is essential for the reputation and legal standing of the business.

Is there a certification requirement associated with the form?

Yes, the Georgia C 15 form includes a certification section. The individual filing the report must certify, under penalties of perjury, that the information provided is true and correct to the best of their knowledge. This certification is a critical component of the form, as it underscores the importance of accuracy and honesty in reporting.

Can additional pages be attached to the form?

Absolutely. If the number of unserviced preneed funeral contracts exceeds the space available on the form, additional pages can be attached. Each attached page must contain the same detailed information for every contract holder as required on the original form. This allows for comprehensive reporting while ensuring compliance with state regulations.

Where should the completed Georgia C 15 form be submitted?

The completed Georgia C 15 form should be submitted to the Georgia Secretary of State’s office, specifically to the Division of Securities and Business Regulation. The address for submission is 2 Martin Luther King Jr. Drive, S.E., Suite 802 West Tower, Atlanta, Georgia 30334. It is advisable to keep a copy of the submitted form for your records.

Who can I contact for assistance with the form?

If you have questions or need assistance with the Georgia C 15 form, you can contact the Georgia Secretary of State’s office directly at (404) 656-3920. They can provide guidance on completing the form, understanding the requirements, and addressing any specific concerns you may have regarding preneed funeral contracts.

Common mistakes

  1. Incomplete Information: One common mistake is failing to provide all required details. Each section of the form must be filled out completely. This includes the registration number, contact information, and details about each preneed funeral contract. Leaving any of these fields blank can lead to delays or rejection of the submission.

  2. Incorrect Dates: Another frequent error is entering incorrect dates. The form requires specific dates for the contracts, and any discrepancies can cause confusion. Ensure that the date of the report and the dates of the contracts are accurate and match the records.

  3. Not Attaching Necessary Documents: Failing to attach additional pages when needed is a mistake that can be easily avoided. If there are more contracts than can fit on the provided pages, it’s essential to include additional sheets with the same format. Omitting this step can result in incomplete reporting.

  4. Improper Certification: Lastly, many individuals overlook the certification section. It is crucial to sign and date the form, as well as print the name and title of the person authorized to submit the report. Neglecting this step can invalidate the submission.

Documents used along the form

The Georgia C 15 form is an important document for reporting unserviced preneed funeral contracts. Alongside this form, there are several other documents that may be required or useful in the process. Below is a list of these forms, each described briefly to help you understand their purpose.

  • Preneed Funeral Contract: This is the actual agreement between the funeral home and the consumer, outlining the services and products to be provided in the future. It details the costs and payment terms.
  • Escrow Agreement: This document establishes the terms under which funds for preneed contracts are held in an escrow account. It ensures that the money is available for use when the services are needed.
  • Annual Financial Statement: This statement provides a comprehensive overview of the financial health of the funeral home, including assets, liabilities, and net worth. It may be required to demonstrate compliance with financial regulations.
  • Client Disclosure Statement: This form is provided to clients at the time of entering into a preneed contract. It includes important information about the contract, such as cancellation policies and rights.
  • Certificate of Authority: This document certifies that the funeral home is licensed to operate in Georgia. It is essential for legal compliance and consumer trust.
  • Report of Unserviced Contracts: Similar to the C 15 form, this report provides details about unserviced contracts but may focus on different aspects or be formatted differently based on specific regulatory requirements.
  • Supporting Documentation: This includes any additional paperwork that supports the information provided in the C 15 form, such as proof of deposits or correspondence with clients regarding their contracts.

Understanding these documents can help ensure compliance with Georgia's regulations regarding preneed funeral contracts. Keeping accurate records and filing the necessary forms is crucial for maintaining trust and transparency with clients.

Similar forms

The Georgia C 15 form is similar to several other documents that serve various reporting and certification purposes. Here’s a list of nine documents that share similarities with the Georgia C 15 form:

  • Annual Financial Report: Like the C 15 form, this report provides a summary of financial activities over the year and may require certification of accuracy.
  • Business License Renewal Application: This document also requires detailed information about the business, including contact details and compliance with state regulations.
  • Pre-Need Funeral Contract Disclosure: Similar to the C 15, this document outlines the terms and conditions of pre-need contracts and must be filed with the state.
  • Trust Fund Report: This report details the status of funds held in trust for pre-need contracts, similar to how the C 15 details unserviced contracts.
  • Sales Tax Return: This document requires businesses to report sales and remit taxes, often needing certification that the information is accurate.
  • Corporate Annual Report: Much like the C 15 form, this report provides an overview of a corporation’s activities and financial status for the year.
  • State Compliance Report: This document ensures that a business is adhering to state regulations, similar to the compliance aspects of the C 15 form.
  • Consumer Protection Report: This report often requires businesses to disclose practices and policies, akin to the transparency required in the C 15 form.
  • Escrow Account Statement: This document details the funds held in escrow for pre-need contracts, paralleling the financial details required in the C 15 form.

Dos and Don'ts

When filling out the Georgia C 15 form, consider the following important guidelines:

  • Do read the instructions that accompany the form carefully.
  • Do provide accurate and complete information for each contract holder.
  • Do include your contact information for any follow-up questions.
  • Do ensure that all required deposits have been made to the preneed escrow account.
  • Don't leave any sections of the form blank; all fields must be filled out.
  • Don't forget to sign and date the certification section of the form.
  • Don't submit the form without double-checking for accuracy.

Misconceptions

The Georgia C 15 form is an important document for funeral homes managing preneed funeral contracts. However, several misconceptions surround its purpose and requirements. Understanding these can help ensure compliance and proper reporting. Below are seven common misconceptions about the Georgia C 15 form:

  1. It is optional to file the form. Many believe that submitting the Georgia C 15 form is optional. In reality, it is mandated by state law, specifically O.C.G.A. 10-14-12(g), and must be filed annually.
  2. Only large funeral homes need to file. Some think that only larger funeral homes are required to complete this form. However, any funeral home with unserviced preneed contracts must submit the report, regardless of size.
  3. The form only tracks financial information. While financial details are a significant part of the form, it also requires information about the contract holders and the status of each preneed contract.
  4. Filing late has no consequences. There is a belief that late submission of the form will not result in any penalties. In fact, failure to file on time can lead to fines or other regulatory actions against the funeral home.
  5. All contracts must be serviced by the end of the year. Some may assume that all preneed contracts must be fulfilled by December 31st. The form is specifically for unserviced contracts, which means it is expected that some contracts will remain unfulfilled.
  6. Only the owner can sign the form. It is a common misconception that only the owner of the funeral home can certify the information on the form. Any authorized individual can sign, as long as they have the authority to represent the business.
  7. The information provided is not confidential. There is a concern that the details submitted in the form will be publicly accessible. While the form is a public document, sensitive information is typically protected to ensure privacy for contract holders.

By clarifying these misconceptions, funeral homes can better navigate the requirements associated with the Georgia C 15 form and ensure compliance with state regulations.

Key takeaways

Filling out the Georgia C 15 form is an important process for funeral homes managing preneed contracts. Here are some key takeaways to keep in mind:

  • Understand the Purpose: The form is required to report all unserviced preneed funeral contracts as of December 31 each year.
  • Follow the Instructions: Always read the accompanying instructions carefully to ensure compliance with O.C.G.A. 10-14-12(g).
  • Accurate Information: Ensure that all information provided, including the registrant's name, address, and contact details, is accurate and up to date.
  • Detail Each Contract: Provide complete details for each unserviced contract, including the contract holder's name, total amount, and bank account number.
  • Attach Additional Pages: If there are more contracts than can fit on the form, attach additional pages with the same information format.
  • Certification Requirement: The form must be certified, confirming the truthfulness of the information provided, and must be signed by an authorized individual.
  • Submission Deadline: Be mindful of submission deadlines to avoid penalties or issues with compliance.

By keeping these points in mind, funeral homes can ensure they meet their reporting obligations effectively and accurately.