Today is

Online Application for an Establishment

Funeral Establishment License Application Mississippi State Board Of Funeral Service 3010 Lakeland Cove Suite W Flowood, Mississipps 39232 601-932-1973     * Legal Name of Establishment : If Branch, list the Main Establishment: (Branch must have same owners as the Main Establishment owners) Address :   City, State, Zip : Select Alabama Alaska Arkansas Arizona California Colorado Connecticut Washington, DC Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming County : Select Adams Alcorn Amite Attala Benton Bolivar Calhoun Carroll Chickasaw Choctaw Claiborne Clarke Clay Coahoma Copiah Covington DeSoto Forrest Franklin George Greene Grenada Hancock Harrison Hinds Holmes Humphreys Issaquena Itawamba Jackson Jasper Jefferson Jefferson Davis Jones Kemper Lafayette Lamar Lauderdale Lawrence Leake Lee Leflore Lincoln Lowndes Madison Marion Marshall Monroe Montgomery Neshoba Newton Noxubee Oktibbeha Panola Pearl River Perry Pike Pontotoc Prentiss Quitman Rankin Scott Sharkey Simpson Smith Stone Sunflower Tallahatchie Tate Tippah Tishomingo Tunica Union Walthall Warren Washington Wayne Webster Wilkinson Winston Yalobusha Yazoo Business Phone : Fax : Emergency Phone : Email :     * Type of Establishment Funeral Establishment Branch Establishment Commerical Mortuary Service Crematory * Type Ownership Individual Partnership Corporation   Password : This password will be used to login and make changes to your information or to renew online. Mailing Address: Same as address above Address:   City, State, Zip: Select Alabama Alaska Arkansas Arizona California Colorado Connecticut Washington, DC Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming ESTABLISHMENT DESCRIPTION Does the embalming room have hot and cold running water? Yes    No What type of floor is in the Preparation Room: Concrete Tile Other   Describe if other: What type of materials are the walls: Type of Ventilation: Current embalming log? Yes    No Selection room with a minimum of six (6) caskets or twenty-four (24) quarter caskets   Chapel Yes    No Type of Ventilation * Required