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Pre-Need Funeral Contract Sales Annual Report SFN 51531 - North Dakota
| Pre-Need Funeral Contract Sales Annual Report Form. This is a North Dakota form and can be used in Securities Blue Sky Secretary Of State . |
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PRE-NEED FUNERAL CONTRACT SALES ANNUAL REPORT NORTH DAKOTA SECURITIES DEPARTMENT SFN 51531 (3-2012) FORM P-2 Securities Department 600 E Boulevard Ave Bismarck ND 58505 (701) 328-2910 www.ndsecurities.com Calendar Year: Filing Fee: $15.00 A: Name of funeral establishment or cemetery association. B: Address of funeral establishment or cemetery association. C: Telephone number of funeral establishment or cemetery association. D: Name of manager or operator. E: The total number of pre-need funeral service contracts entered into during the calendar year covered by this report: F. The total in dollars of all funds received in payment for pre-need funeral service contracts for the calendar year covered by this report, do not include interest earned: $ G. The total dollars released by a financial institution during the calendar year covered by this report prior to the death of the person for whose benefit the funds were paid: $ H. The total in dollars released by a financial institution during the calendar year covered by this report to the entity named in "A" above: $ I: The total in dollars of all funds received since July 1, 1973, which are undrawn, unexpended and on deposit in a financial institution: $ On the enclosed sheet provide legibly the following information for each pre-need funeral service contract entered into the calendar year covered by this report: (1) The name of the purchaser; (2) The name of the beneficiary (3) Amount paid by the purchaser; (4) Amount deposited by the entity name in "A" above; (5) Date of the contract; and (6) Name and complete mailing address of the financial institution in which the consideration was deposited. *Footnote - The term "financial institution" means a bank, credit union, savings and loan association or trust company. (Date) (Signature) American LegalNet, Inc. www.FormsWorkFlow.com J: SFN 51531 (3-2012) Page 2 of 3 Calendar Year: PRE-NEED FUNERAL SERVICE CONTRACT REPORT - SCHEDULE Name of Funeral Establishment or Cemetery Association: NAME OF PURCHASER NAME OF BENEFICIARY AMOUNT PAID AMOUNT DEPOSITED DATE OF CONTRACT Name and Complete Mailing Address for each Financial Institution American LegalNet, Inc. www.FormsWorkFlow.com SFN 51531 (3-2012) Page 3 of 3 Calendar Year: PRE-NEED FUNERAL SERVICE CONTRACT REPORT - SCHEDULE Name of Funeral Establishment or Cemetery Association: NAME OF PURCHASER NAME OF BENEFICIARY AMOUNT PAID AMOUNT DEPOSITED DATE OF CONTRACT Name and Complete Mailing Address for each Financial Institution American LegalNet, Inc. www.FormsWorkFlow.com
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