Follow the steps to complete the Embalming Certificate Format online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Indicate the report type by choosing between 'Funeral Director' or 'Embalmer' at the top of the form.
3. Fill in the provisional licensee's name in the designated field, ensuring to double-check for accuracy.
4. Enter the license number associated with the provisional licensee.
5. Specify the reporting period by providing the start date and end date in the corresponding fields.
6. Provide the name, address, and license number of the funeral establishment where the provisional activities were conducted.
7. Record the name of the Funeral Director in Charge or Embalmer in Charge in the related field.
8. Input the license number of the Funeral Director or Embalmer In Charge to ensure proper documentation.
9. List the name of the deceased for each case in the provided area, ensuring to follow the checklist for direct supervision.
10. For each listed case, document the date the activities were performed.
11. Enter the printed name and license number of the supervisor for each corresponding case.
12. Ensure that the supervisor’s signature is provided next to each case entry.
13. Once all cases are documented, review the form for any missing information or errors.
14. Sign the form as the provisional licensee, ensuring your signature is placed correctly.
15. Obtain the signature of the Funeral Director In Charge or Embalmer In Charge, as applicable.
16. Finally, save the changes, and you may download, print, or share the completed form for further processing.

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