N.Y. Comp. Codes R. & Regs. tit. 10 § 78.2

Current through Register Vol. 46, No. 51, December 18, 2024

Section 78.2 - Format for statement of goods and services selected

The statement of goods and services selected shall be in the following format:

ITEMIZATION OF FUNERAL SERVICES AND MERCHANDISE SELECTED

The following are the charges for the services, merchandise and livery you have selected. You will not be charged for any item you do not choose unless it is necessary because of other selections you have made. Any such charges are explained below.

I. FUNERAL HOME CHARGES (Indicate N/A for items of service and/or merchandise that are not provided.)

A. Alternative Services

1. Direct Cremation $ __....................................

2. Direct Burial $ __..................................................

B. Transfer of remains to the funeral establishment, including personnel, equipment and vehicle. $ __...............................................

C. Preparation of Remains

1. Embalming (including use of preparation room) $ __ ............

If you select a funeral for which this firm requires embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you do not approve if you select arrangements such as direct cremation or direct burial. If we charge for embalming, we will explain why below.

2. Other preparation (including use of preparation room but excluding embalming)

a. Topical Disinfection $ __.....................................................................

b. Custodial Care $ __....................................................................

c. Dressing/Casketing $ __...........................................................

d. Cosmetology $ __....................................................................

e. Restoration $ __.....................................................................

f. Other (specify) _________ $ __................................................................................... ______________

D. Arrangements

$ __

Basic arrangements: including funeral director, other staff, equipment and facilities to respond to initial request for service, the arrangement conference, securing of necessary authorizations and coordination of service plans with parties involved in the final disposition of the deceased.

E. Supervision (funeral director and staff)

1. Supervision for visitation $ __.................................................................................

2. Supervision for funeral service $ __.......................................................................

3. Other supervision (specify) _________ $ __........................................................................... _________________

F. Use of the Facilities

1. Use of the facilities for visitation $ __...............................................

2. Use of facilities for funeral service $ __......................................................................

3. Other use of facilities (specify) _________..... $ ..................................................... _____________________

G. Livery

a. Hearse or $ __..................................................

b. Alternative vehicle $ __.........................................

(Specify type: _________.......................................................

)

2. Flower vehicle $ __....................................

3. Limousine(s) $ __............................................

(Specify number: __@ $__/limousine)

4. Passenger car(s) $ __...................................................

(Specify number: __@$__/car)

H. Merchandise $ __..............................................................

1. Casket or Alternative Container $ __................................................

a. Supplier

b. Model name or number

c. Material: Species of wood_______________________________________

or kind of metal

weight or

_gauge __ or alternative container (describe)____________________________

d. Interior..................................................

2. Outer Interment Receptacle $ __.................................................................................................................................................

Supplier

_______________________________________________________

...................................................................................................................

Model name or number

_______________________________________________________

...................................................................................................................

Material

_______________________________________________________

I. Additional Services and Merchandise Selected

(Describe and show price)

1. ______________ $ __.................................................

2. ______________ $ ___.................................................

3. ______________ $ ___.................................................

4. ______________ $ ___.................................................

J. Limited Services

1. Forwarding remains to __________ $ ___.................................................

2. Receiving remains from _________ $ ___.................................................

TOTAL OF FUNERAL HOME CHARGES $ ___.................................................

II. CASH ADVANCES

These are estimated charges for items to be paid to others. We will charge you no more for these items than is actually paid the third parties. (Describe and show estimated charges.)

1. ______________ $ ___.................................................

2. ______________ $ ___.................................................

3. ______________ $ ___.................................................

4. ______________ $ __ _.................................................

ESTIMATED TOTAL OF CASH ADVANCES $ ___.................................................

III. SUMMARY OF CHARGES

1. Funeral Home Charges $ ___.................................................

2. Cash Advances $ ___.................................................

TOTAL FUNERAL CHARGES $ ___.................................................

IV. EXPLANATION OF CHARGES

Explain charges for embalming and for any items that are not required by law but may be necessary because of cemetery requirements, crematory requirements or other selections made.

_______________________________________________________

Signature of Licensed Funeral Director Date......................................................

Printed or Typed Name of Funeral Director

ACKNOWLEDGMENT OF RECEIPT

I have received this itemization of funeral services

and merchandise selected.

Signature of Licensed Funeral Director Date....................................................

PUBLIC NOTICE

The New York State Department of Health is responsible for licensing and regulating New York State funeral directing under the Public Health Law.

You may contact the Department at:

Bureau of Funeral Directing

New York State Department of Health

Corning Tower, Empire State Plaza

Albany, NY 12237

N.Y. Comp. Codes R. & Regs. Tit. 10 § 78.2