Fill a Valid Georgia C 15 Template
Article Structure
Common mistakes
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Incomplete Information: Failing to provide all required details can lead to delays or rejections. Ensure every section is filled out completely, including names, addresses, and contact information.
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Incorrect Dates: Entering the wrong date for the contracts can cause significant issues. Double-check the dates to ensure they align with the reporting period.
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Missing Signatures: Neglecting to sign the certification section is a common oversight. The report must be signed by an authorized person to be valid.
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Not Attaching Additional Pages: If there are more contracts than can fit on the form, failing to attach additional pages can lead to incomplete reporting. Make sure to include all necessary information for every contract holder.
Essential Points on This Form
What is the purpose of the Georgia C 15 form?
The Georgia C 15 form is used to report and itemize all unserviced preneed funeral contracts as of December 31 of the reporting year. This report is required by Georgia law under O.C.G.A. 10-14-12(g). It helps ensure transparency and accountability in the management of preneed funeral contracts, providing necessary information to the Georgia Secretary of State's office.
Who is required to file the Georgia C 15 form?
Funeral homes and registrants that hold preneed funeral contracts must file the Georgia C 15 form. If a funeral home has unserviced contracts as of December 31, they are mandated to complete and submit this report to remain compliant with state regulations.
What information is needed to complete the Georgia C 15 form?
To complete the Georgia C 15 form, you will need to provide several details. This includes your registration number, total number of unserviced contracts, and contact information. Additionally, you must list each unserviced preneed funeral contract, detailing the contract holder's name, depository, date of contract, total amount, amount paid to date, and the bank account number. You may need to attach additional pages if you have multiple contracts to report.
What happens if I do not file the Georgia C 15 form?
Failing to file the Georgia C 15 form can lead to penalties, including fines or other disciplinary actions from the state. It is crucial to adhere to the filing requirements to avoid any legal issues and to maintain good standing with the Georgia Secretary of State’s office.
How do I certify the information provided on the Georgia C 15 form?
Certification is done in Part III of the form. The individual authorized to sign on behalf of the funeral home must confirm that all information is accurate and complete. This person must also state that all required deposits have been made to the preneed escrow account. The certification must include their signature, printed name, title, and date.
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Georgia 5579 - The completed form is part of the necessary documentation for background checks.
Georgia C 15 Sample
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STATE OF GEORGIA |
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Brian P. Kemp |
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SECURITIES AND BUSINESS REGULATION |
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Robert D. Terry |
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Secretary of State |
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2 Martin Luther King Jr. Drive, S.E. |
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Division Director |
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Suite 802 West Tower |
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Atlanta, Georgia 30334 |
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(404) |
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REPORT AND ITEMIZED LIST OF ALL UNSERVICED PRENEED FUNERAL CONTRACTS |
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AS OF 12/31/200__ |
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This report is mandated by O.C.G.A. |
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Please read instructions accompanying this form. |
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PART 1 - GENERAL |
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Registration Number |
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Total number of unserviced |
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Phone Number |
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contracts as of |
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Name of Registrant/Funeral Home |
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Mailing Address |
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City |
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Zip Code |
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Location of Records |
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Name and phone number of contact person regarding this report: |
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PART II - UNSERVICED PRENEED FUNERAL CONTRACTS |
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Contract Holder Name and |
Depository |
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Date of |
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Contract |
Total Amount |
Amount |
Total Amount |
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Bank Account Number |
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Contract |
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Number |
of Contract |
Paid to Date |
on Deposit |
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TOTAL (Page 1) |
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TOTAL (Page 2) |
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TOTAL OF ALL PAGES |
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Attach additional pages, as necessary, with complete information as above on every contract holder.
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PART II - UNSERVICED PRENEED FUNERAL CONTRACTS
Contract Holder Name and |
Depository |
Date of |
Contract |
Total Amount |
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Amount |
Total Amount |
Bank Account Number |
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Contract |
Number |
of Contract |
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Paid to Date |
on Deposit |
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TOTAL (Page 2) |
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Attach additional pages, as necessary, with complete information as above on every contract holder. |
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PART III - CERTIFICATION |
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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: |
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Date |
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Form |
page 2 |
Key takeaways
When filling out and using the Georgia C 15 form, it is essential to keep the following key takeaways in mind:
- Understand the Purpose: The Georgia C 15 form is designed to report all unserviced preneed funeral contracts as of December 31 each year. This report is mandated by state law, ensuring transparency and accountability in the funeral service industry.
- Accurate Information is Crucial: It is vital to provide complete and accurate information for each contract holder. This includes details such as the contract holder's name, total amounts, and bank account numbers. Any inaccuracies could lead to legal repercussions.
- Certification Requirement: The form includes a certification section where the signer attests that the information is true and correct. This certification must be signed by an authorized individual, emphasizing the importance of honesty in reporting.
- Additional Pages: If necessary, attach additional pages to include all contract holders. Each page must maintain the same format to ensure clarity and consistency in reporting.
Document Characteristics
| Fact Name | Description |
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| Governing Law | The Georgia C 15 form is governed by O.C.G.A. 10-14-12(g). |
| Purpose | This form serves as a report and itemized list of all unserviced preneed funeral contracts as of December 31st of the reporting year. |
| Filing Requirement | Funeral homes must complete and submit this form annually to comply with state regulations. |
| Contact Information | The form requires the name and phone number of a contact person for inquiries regarding the report. |
| Certification | The signer must certify that the information is true and correct under penalties of perjury. |
| Additional Pages | Additional pages can be attached if necessary, with complete information for each contract holder. |