FILED NOV. 18 2012 CHIEF FINANCIAL OFFICER, JEFF ATWATER Docketed by STATE OF FLORI IN THE MATTER OF: GLOBAL MORTUARY CASENO.: 122746-12-FC (License Number: F039911) / ADMINISTRATIVE COMPLAINT TO: GLOBAL MORTUARY 7210 ULMERTON ROAD SUITE J LARGO, FL 33771 You, GLOBAL MORTUARY, are hereby notified that the Division of Funeral, Cemetery and Consumer Services has directed an investigation in connection with your license to operate as a Funeral Establishment. The allegations set forth below are based on the aforementioned investigation. GENERAL ALLEGATIONS 1. The Board of Funeral, Cemetery, and Consumer Services (“Board”), created within the Division of Funeral, Cemetery and Consumer Services (“Division”), and the Department of Financial Services (“Department”), have jurisdiction over your licensure as a Funeral Establishment and the subject matter of this proceeding, pursuant to the provisions of Section 20,121, and Chapter 497, Florida Statutes. 2. The Board has the authority to determine through probable cause panels whether there is probable cause to believe there is a violation of Chapter 497, Florida Statutes, and whether a proposed administrative prosecution of a licensee shall go forward, as set forth in 1 Sections 497,103(1)(v) and 497.153(3), Florida Statutes. 3. A probable cause panel on June 25, 2012, found probable cause to charge you with violations of Chapter 497, Florida Statutes, and the Department’s administrative rules, and directed the Department to prosecute the matter, 4. On or about December 11, 1980, International Funeral Home became incorporated, The aforementioned corporation was formerly known as International Chapels before changing to All County Funeral Home, Inc. which was subsequently changed to All American Funeral Home, Inc, which has been renamed/reacquired by International Funeral Home. 5. On or about April 2, 1979, International Association of Mortuary Service became incorporated. International Association of Mortuary Services is associated and has done business through the International Funeral Home, Inc, corporate name. 6. On or about May 20, 1980, International Association of Mortuary Services was licensed as a Direct Disposer in the State of Florida having been issued license number F040432, As of November 6, 2002, International Association of Mortuary Services is no longer licensed as a Direct Disposer in the State of Florida, 7. On or about February 10, 1981, International Funeral Home was licensed as a Funeral Establishment in the State of Florida having been issued license number F040482, As of November 6, 2002, International Funeral Home is no longer licensed as a Funeral Establishment ‘in the State of Florida, | 8. On or about July 8, 2002, International Association of Mortuary Services, Inc. received a Preneed Main license (37-00), license number F021730, pursuant to the provisions of Chapter 497, Florida Statutes, The license expired July 1, 2003. 9. At all times relevant since their formations and subsequent name changes, John Ross Competiello was President of International Funeral Home. 10. Atall times relevant since their formation and subsequent name changes, Audrey Calabrette was the Secretary and Treasurer of International Funeral Home. 11. International Association of Mortuary Services, Inc. and International Funeral Home were located at 4617 73° Avenue North, Pinellas Park, Florida 34665. 12. | On or about November 6, 2002, International Association of Mortuary Services, Inc, and International Funeral Home were dissolved as corporations in the State of Florida. 13. On or about April 21, 2003, International Mortuary was formed as a Florida For Profit Corporation, , 14, On or about February 17, 2005, International Mortuary filed documents with the State for a change of name to Global Mortuary. 15. You, GLOBAL MORTUARY, are licensed as a Funeral Establishment in the State of Florida having been issued license number F03991 1. 16. International Mortuary is not licensed nor has it ever been licensed as a Funeral Establishment in the State of Florida. 17. International Mortuary and Global Mortuary were both located at 7210 Ulmerton Road Suite J, Largo, FL 33771. 18. At all times relevant since their formations and subsequent name changes, John Ross Competiello was President of International Mortuary and Global Mortuary. 19, Onor about October 18, 1995, International Gulf Breeze Chapel was licensed as a Funeral Establishment in the State of Florida having been issued license number F041041. As of July 28, 2005, International Gulf Breeze Chapel no longer holds a valid Funeral Establishment license in the state of Florida. 20. International Gulf Breeze Chapel was located at 7210 Ulmerton Road Suite J, Largo, FL 33771. 21. On or about June 30, 2011, an examiner with the Division conducted an investigation of GLOBAL MORTUARY, Count I 22, The above General Allegations are hereby re-alleged and fully incorporated herein by reference. 23. During the investigation it was determined that you, GLOBAL MORTUARY, made false statements when applying for a change of ownership in licensure, 24, On or about June 27, 2005, John Competiello, President of GLOBAL MORTUARY, applied for a change of ownership with the Department of Business and Professional Regulation (“DBPR’). 25, In the application, DBPR requested that the Licensee disclose any previous discipline. 26. On or about May 2, 1996, a Final Order (Case No.: 91-16425; 93-01990) was issued as pertains to John Competiello’s licensure as a Funeral Director and Embalmer in the State of Florida. In that Final Order, John Competiello agreed to voluntarily relinquish his Funeral Director’s Licensure to the Board of Funeral Directors and Embalmers, 27, You, GLOBAL MORTUARY, submitted to DBPR an application that failed to include the previous disciplinary history of John Competiello, as requested. IT IS THEREFORE CHARGED that you, GLOBAL MORTUARY, have violated or are accountable under one or more of the following provisions of the Florida Statutes, which constitutes sufficient grounds for the suspension or revocation of your license as a Funeral Establishment in this state: (a) Section 497,152(1)(a), Florida Statutes, which provides that it is a violation to violate any provision of this chapter or any lawful order of the board or department or of the statutory predecessors to the board or department. (b) Section 497,152(1)(b), Florida Statutes, which provides that it is a violation to commit fraud, deceit, negligence, incompetency, or misconduct in the practice of any of the activities regulated under this chapter. (c) Section 497,152(4)(e), Florida Statutes, which provides that it is a violation to knowingly concealing information relative to violations of this chapter. (d) Section 497,152(4)(f), Florida Statutes, which provides that it is a. violation to make or file a report or statement to or with any government entity that the license knows or has reason to know to be false; or intentionally or negligently failing to file a report or record | required to be filed with any government entity, or willfully impeding or obstructing another person to do so, or inducing another person to impede or obstruct such filing. (e) Section 497,159, Florida Statutes, makes it a crime the act of knowingly giving false information in the course of applying for or obtaining a license under this chapter, with intent to mislead the board or a public employee in the performance of her or his official duties, or the act of attempting to obtain or obtaining a license under this chapter by knowingly misleading statements or knowing misrepresentations, constitutes a felony of the third degree, Count II 28. The above General Allegations are hereby re-alleged and fully incorporated herein by reference. 29. During the investigation it was determined that you, GLOBAL MORTUARY, are located at 7210 Ulmerton Road, Suite J, Largo, Florida 33771. 30. You, GLOBAL MORTUARY, have operated at this location since 2004. 31. During the investigation it was determined that International Gulf Breeze Chapel was also located at 7210 Ulmerton Road, Suite J, Largo Florida, 33771. 32. During the investigation it was determined that International Gulf Breeze Chapel terminated operations in 2005. 33, You, GLOBAL MORTUARY, operated your business in conjunction with a pre- existing funeral home at the same location from 2004-2005. 34. Neither GLOBAL MORTUARY nor International Gulf Breeze Chapel are licensed as colocated establishments. | 35. You, GLOBAL MORTUARY, knowingly and willfully operated a funeral establishment without regard to the procedures of the Funeral, Cemetery, and Consumer Services Act. IT IS THEREFORE CHARGED that you, GLOBAL MORTUARY, have violated or are accountable under one or more of the following provisions of the Florida Statutes, which constitutes sufficient grounds for the suspension or revocation of your license as a Funeral Establishment in this state: (a) Section 497.152(1)(a), Florida Statutes, which provides that it is a violation to violate any provision of this chapter or any lawful order of the board or department or of the statutory predecessors to the board or department. . (b) — Section 497,152(1}(b), Florida Statutes, which provides that it is a violation to commit fraud, deceit, negligence, incompetency, or misconduct in the practice of any of the activities regulated under this chapter. (c) Section 497.380(3), Florida Statutes, which provides that no person may conduct, maintain, manage, or operate a funeral establishment unless a funeral establishment operating license has been issued under this chapter for that funeral establishment. (d) Section 497.3809), Florida Statutes, which provides that each funeral establishment located at a specific address shall be deemed to be a separate entity and shall require separate licensing and compliance with the requirements of this chapter. A funeral establishment may not be operated at the same location as any other funeral establishment or direct disposal establishment unless such establishments were licensed as colocated establishments on October 1, 1993, (e) Section 497.380(12)(a), Florida Statutes, which provides that a change in ownership of a funeral establishment shall be promptly reported pursuant to procedures established by rule and shall require the relicensure of the funeral establishment, including reinspection and payment of applicable fees. | (f) Section 497,152(5)(c), Florida Statutes, which provides that it is a violation to represent as her or his own the license of another, ‘ount JIT 36. The above General Allegations are hereby re-alleged and fully incorporated herein by reference. 37, During the inspection it was determined you, GLOBAL MORTUARY, were contracted to embalm the body of Jason Colon. 38. On or about December 28, 2009, you, GLOBAL MORTUARY, embalmed the body of Jason Colon, 39, On or about December 30, 2009, you, GLOBAL MORTUARY, arranged to ship- out the embalmed body of Jason Colon to a funeral establishment in Pennsylvania. 40, You, GLOBAL MORTUARY, or an employee of Global Mortuary, failed to put the viscera of Jason Colon back into his chest cavity before shipping out the embalmed body, 41. In fact, you, GLOBAL MORTUARY, did not even inform the family or the funeral establishment (that arranged for ship-out) that the viscera was not included with the embalmed body of Jason Colon. 42. Furthermore, it was determined that you, GLOBAL MORTUARY, or an employee of Global Mortuary, failed to treat the remains of Jason Colon with respect and dignity, You, GLOBAL MORTUARY, or an employee of Global Mortuary, put a soiled towel in the bag that contained the viscera of Jason Colon. 43, You, GLOBAL MORTUARY, failed to ensure that viscera remains were with the body of Jason Colon, This created a serious danger to public health and safety. IT IS THEREFORE CHARGED that you, GLOBAL MORTUARY, have violated or are accountable under one or more of the following provisions of the Florida Statutes, which constitutes sufficient grounds for the suspension or revocation of your license as a Funeral Establishment in this state: (a) Section 497,152(1)(a), Florida Statutes, which provides that it is a violation to violate any provision of this chapter or any lawful order of the board or department or of the statutory predecessors to the board or department, (b) — Section 497,152(1)(b), Florida Statutes, which provides that it is a violation to commit fraud, deceit, negligence, incompetency, or misconduct in the practice of any of the activities regulated under this chapter. (c) Section 497,152(4)(d), Florida Statutes, which provides that it is a violation to fail to report to the department any violation of this chapter by another person, which violation is known to the licensee to have created or be creating a serious and immediate danger to the public health, safety, or welfare. (d) — Section 497.386(4), Florida Statutes, which provides the licensing authority shall establish by rule the minimal standards of acceptable and prevailing practices for the handling and storing of dead human bodies, provided that all human remains transported or stored must be completely covered and at all times treated with dignity and respect, Count IV 44, The above General Allegations are hereby re-alleged and fully incorporated herein by reference. 45, During the inspection it was determined you, GLOBAL MORTUARY, failed to ensure that signed and dated contracts were provided to multiple consumers, 46. During the inspection it was determined you, GLOBAL MORTUARY, allowed John Competiello, an unlicensed individual, to sign multiple contracts for services with consumers, IT IS THEREFORE CHARGED that you, GLOBAL MORTUARY, have violated or are accountable under one or more of the following provisions of the Florida Statutes, which constitutes sufficient grounds for the suspension or revocation of your license as a Funeral Establishment in this state: (a) Section 497.152(1)(a), Florida Statutes, which provides that it is a violation to violate any provision of this chapter or any lawful order of the board or department or of the statutory predecessors to the board or department. (b) — Section 497,152(1)(b), Florida Statutes, which provides that it is a violation to commit fraud, deceit, negligence, incompetency, or misconduct in the practice of any of the activities regulated under this chapter. (c) Section 497,452(11)(a), Florida Statutes, which provides that it is a violation to fail to furnish, for retention, to each purchaser of burial rights, burial or funeral merchandise, or burial or funeral services a written agreement, the form of which has been previously approved if 9 and as required by this chapter, that lists in detail the items and services purchased together with the prices for the items and services purchased; the name, address, and telephone number of the licensee; the signatures of the customer and the licensee or her or his representative; and the date signed, (d) — Section 497,152(5)(e), Florida Statutes, which provides that it is a violation to aide, assist, procure, employ, or advise any person or entity to practice a profession or occupation regulated by this chapter without required licensure under this chapter. Count V 47, The above General Allegations are hereby re-alleged and fully incorporated herein by reference. 48. During the investigation it was determined that you, GLOBAL MORTUARY, were still in possession of preneed funeral arrangement forms. 49, You, GLOBAL MORTUARY, do not have a valid preneed main license nor have you ever maintained a valid preneed main license. 50. As previously alleged, John Competiello was the President of International Association of Mortuary Services. On or about July 1, 2003, International Association of Mortuary Services’ Preneed Main licensure expired. The Division was informed that all preneed contracts were transferred to International Casket & Urn Gallery. 51, During the investigation it was determined that you, GLOBAL MORTUARY, operated as International Casket & Urn Gallery in that you, GLOBAL MORTUARY, filled the contracts International Casket was required to fulfill, 52. You, GLOBAL MORTUARY, fulfilled contracts that were allegedly transferred to and in the possession of International Casket & Urn Gallery. These contracts were fulfilled at 10 your, GLOBAL MORTUARY’s, principal place of business located at 7210 Ulmerton Road, Suite J, Largo, Florida 33771. IT IS THEREFORE CHARGED that you, GLOBAL MORTUARY, have violated or are accountable under one or more of the following provisions of the Florida Statutes and/or the Florida Administrative Code, which constitutes sufficient grounds for the suspension or revocation of your license as a Funeral Establishment in this state: (a) Section 497,152(1)(a), Florida Statutes, which provides that it is a violation to violate any provision of this chapter or any lawful order of the board or department or of the statutory predecessors to the board or department. (b) Section 497,152(1)(b), Florida Statutes, which provides that it is a violation to commit fraud, deceit, negligence, incompetency, or misconduct in the practice of any of the activities regulated under this chapter. (c) Section 497.152(4)(e), Florida Statutes, which provides that knowingly concealing information relative to violations of this chapter. (d) Section 497,152(4)(f), Florida Statutes, which provides that it is a violation to make or file a report or statement to or with any government entity that the license knows or has reason to know to be false; or intentionally or negligently failing to file a report or record required to be filed with any government entity, or willfully impeding or obstructing another person to do so, or inducing another person to impede or obstruct such filing. (e) Section 497,152(4)(h), Florida Statutes, which provides that is a violation to fail to perform any statutory or legal obligation placed upon a licensee. (f) Section 497,380(9), Florida Statutes, which provides that each funeral establishment located at a specific address shall be deemed to be a separate entity and shall require separate licensing and compliance with the requirements of this chapter. A funeral 11 establishment may not be operated at the same location as any other funeral establishment or direct disposal establishment unless such establishments were licensed as colocated establishments on October 1, 1993, Count VI 53, The above General Allegations are hereby re-alleged and fully incorporated herein by reference, 54, You, GLOBAL MORTUARY, through John Competiello, made false statements to the Division when relinquishing the preneed main license of International Association of Mortuary Services, These false statements include, but are not limited to, assurances that all preneed contracts were transferred from International Association of Mortuary Services to International Casket & Urn Gallery for final disposition, upon request, 55. It was determined during the investigation that you, GLOBAL MORTUARY, allowed John Competiello to withdraw funds from the preneed trust fund when the beneficiary had not died and no goods or services had been provided. 56. You, GLOBAL MORTUARY, failed to ensure that any officer, director, employee, or agent at Global Mortuary did not make unauthorized withdrawals from the preneed trust fund, 57, During the investigation, an examiner with the Division asked John Competiello several questions as pertains to the Preneed Trust Fund withdrawals. Mr. Competiello refused to answers these questions and invoked his 5" amendment right against self-incrimination. 58. You, GLOBAL MORTUARY, failed to answer, through John Competiello, the Division investigator’s questions truthfully and completely. 59, You, GLOBAL MORTUARY, failed to ensure that any officer, director, employee or agent at Global Mortuary complied with the applicable statutes and rules of the state 12 of Florida. ; ITIS THEREFORE CHARGED that you, GLOBAL MORTUARY, have violated or are accountable under one or more of the following provisions of the Florida Statutes and/or the Florida Administrative Code, which constitutes sufficient grounds for the suspension or revocation of your license as a Funeral Establishment in this state: (a) — Section 497,152(1)(a), Florida Statutes, which provides that it is a violation to violate any provision of this chapter or any lawful order of the board or department or of the statutory predecessors to the board or department, (b) — Section 497.152(1)(b), Florida Statutes, which provides that it is a violation to commit fraud, deceit, negligence, incompetency, or misconduct in the practice of any of the activities regulated under this chapter. (c) Section 497.152(4)(e), Florida Statutes, which provides that knowingly concealing information relative to violations of this chapter. (d) Section 497,152(4)(f), Florida Statutes, which provides that it is a violation to make or file a report or statement to or with any government entity that the license knows or has reason to know to be false; or intentionally or negligently failing to file a report or record required to be filed with any government entity, or willfully impeding or obstructing another person to do so, or inducing another person to impede or obstruct such filing, (e) Section 497.152(4)(h), Florida Statutes, which provides that is a violation to fail to perform any statutory or legal obligation placed upon a licensee. (f) Section 497,159(3), Florida Statutes, provides that any person who willfully obstructs the department or its examiner in any examination or investigation authorized by this chapter commits a misdemeanor of the second degree in addition to any disciplinary action under this chapter, 13 (g) Section 497,159(4), Florida Statutes, makes it a crime for any officer or director, or person occupying similar status or performing similar functions, of a preneed licensee who fails to make required deposits to any trust fund required by this chapter; any director, officer, agent, or employee of a prenced licensee who makes any unlawful withdrawal of funds from any such account or who knowingly discloses to the department or an employee thereof any false report made pursuant to this chapter. (h) = Section. 497,380(9), Florida Statutes, which provides that each funeral establishment located at a specific address shall be deemed to be a separate entity and shall require separate licensing and compliance with the requirements of this chapter. A funeral establishment may not be operated at the same location as any other funeral establishment or direct disposal establishment unless such establishments were licensed as colocated ‘establishments on October 1, 1993, Count VII 60. The above General Allegations are hereby ‘re-alleged and fully incorporated herein by reference. 61. During the investigation it was determined that International Funeral Home arranged to fulfill the preneed contracts entered into by, now defunct, Christian Cremation Society. 62. During the investigation it was determined that you, GLOBAL MORTUARY, were in possession of preneed files that were written by Christian Cremation Society. 63. During the investigation it was determined that John Competiello fraudulently requested reimbursement from the Consumer Protection Trust Fund on behalf of Global Mortuary. 64, During the investigation it was determined that John Competiello did not work on 14 - the contract yet requested reimbursement from the Consumer Protection Trust Fund. John Competiello does not hold any valid licensure with the Division of Funeral, Cemetery, and Consumer Services, 65, In essence, you, GLOBAL MORTUARY, were paid twice for the same funeral services, in that you withdrew funds from the Prenced Trust Fund and were paid from the Consumer Protection Trust Fund, 66, You, GLOBAL MORTUARY, failed to ensure that any officer, director, or agent at Global Mortuary did not make any false or fraudulent claims of reimbursement to the Consumer Protection Trust Fund, IT IS THEREFORE CHARGED that you, GLOBAL MORTUARY, have violated or are accountable under one or more of the following’ provisions of the Florida Statutes, which constitutes sufficient grounds for the suspension or revocation of your license as a Funeral Establishment in this state: | @) Section 497,152(1)(a), Florida Statutes, which provides that it is a violation to violate any provision of this chapter or any lawful order of the board or department or of the statutory predecessors to the board or department. (b) — Section 497.152(1)(b), Florida Statutes, which provides that it is a violation to commit fraud, deceit, negligence, incompetency, or misconduct in the practice of any of the activities regulated under this chapter. (c) Section 497,152(4)(e), Florida Statutes, which provides that knowingly concealing information relative to violations of this chapter. (d) Section 497,152(4)(f), Florida Statutes, which provides that it is a violation to make or file a report or statement to or with any government entity that the license knows or has reason. to know to be false; or intentionally or negligently failing to file a report or record 15 required to be filed with any government-entity, or willfully impeding or obstructing another person to do so, or inducing another person to impede or obstruct such filing. (e) Section 497.152(4)(h), Florida Statutes, which provides that is a violation to fail to perform any statutory or legal obligation placed upon a licensee. (f Section 497,159(4), Florida Statutes, makes it a crime for any officer or director, or person occupying similar status or performing similar functions, of a preneed licensee who fails to make required deposits to any trust fund required by this chapter; any director, officer, agent, or employee of a preneed licensee who makes any unlawful withdrawal of funds from any such account or who knowingly discloses to the department or an employee thereof any false report made pursuant to this chapter, (g) Section 497.460, Florida Statutes, which provides that disbursements of funds discharging any preneed contract fulfilled after September 30, 1993, shall be made by the trustee to the preneed licensee upon receipt of a certified copy of the death certificate of the contract beneficiary or satisfactory evidence as established by rule of the licensing authority that the preneed contract has been performed in whole or in part. WHEREFORE, the Department respectfully requests that the Board enter an order imposing one or more of the following penalties on you, GLOBAL MORTUARY, revocation or suspension of license; imposition of an administrative fine not to exceed five thousand dollars ($5,000) for each count or separate offense; issuance of a written reprimand; placement of on , probation; assessment of costs associated with investigation and prosecution; requiring you, GLOBAL MORTUARY, to make restitution; and/or such other penalty or condition as is authorized under section 497,153(5), Florida Statutes. 16 NOTICE OF RIGHTS You have the right to request a proceeding to contest this action by the Board pursuant to Sections 120.569 and 120.57, Florida Statutes, and Rule 28-106, Florida Administrative Code. The proceeding request must be in writing, signed by you, and must be filed with the Department within twenty-one (21) days of your receipt of this notice. Completion of the attached Election of Proceeding form and/or a petition for administrative hearing will suffice as a written request. The request must be filed with DFS Agency Clerk, Julie Jones, Florida Department of Financial Services, 200 East Gaines Street, Tallahassee, Florida 32399-0390. Your written response must be received by the Department no later than 5:00 p.m. on the twenty-first day after your receipt of this notice, Mailing the response on the twenty-first day will not preserve your right to a hearing, YOUR FAILURE TO RESPOND IN WRITING WITHIN TWENTY-ONE (21) DAYS OF YOUR RECEIPT OF THIS NOTICE WILL CONSTITUTE A WAIVER OF YOUR RIGHT TO REQUEST A PROCEEDING ON THE MATTERS ALLEGED HEREIN AND AN ORDER OF SUSPENSION OR REVOCATION WILL BE ENTERED AGAINST YOU, : If you request a proceeding, you must provide information that complies with the requirements of Rule 28-106.2015, Florida Administrative Code. As noted above, completion of the attached Election of Proceeding form conforms to these requirements, Specifically, your response must contain: (a) The name, address, and telephone number, and facsimile number (if any) of the respondent (for the purpose of requesting a hearing in this matter, you are the respondent"). (b) The name, address, telephone number, facsimile number of the attorney or qualified representative of the respondent (if any) upon whom service of pleadings and other papers shall be made. 17 (c) A statement requesting an administrative hearing identifying those material facts that are in dispute. If there are none, the petition must so indicate. . (a) A statement of when the respondent received notice of the administrative complaint. (e) | Astatement including the file number to the administrative complaint. If a hearing of any type is requested, you have the right to be represented by counsel or other qualified representative at your expense, to present evidence and argument, to call and cross-examine witnesses, and to compel the attendance of witnesses and the production of documents by subpoena. If a proceeding is requested and there is no dispute of material fact, the provisions of Section 120.57(2), Florida Statutes, apply. You may submit oral or written evidence in opposition to the action taken by the Board or a written statement challenging the grounds upon which the Board has relied, While a hearing is normally not required in the absence of a dispute of fact, if you feel that a hearing is necessary, one will be conducted in Tallahassee, Florida, or by telephonic conference call upon your request. However, if you dispute material facts which are the basis for the Board’s action, you must request an adversarial proceeding pursuant to Sections 120.569 and 120.57(1), Florida Statutes, These proceedings are held before a State Administrative Law Judge of the Division of Administrative Hearings. Unless the majority of witnesses are located elsewhere, the Department will request that the hearing be conducted in Tallahassee, Florida. Failure to follow the procedure outlined with regard to your response to this notice may result in the request being denied, All prior oral communication or correspondence in this matter shall be considered freeform agency action, and no such oral communication or correspondence shall operate as a valid request for an administrative proceeding, Any request for an 18 administrative proceeding received prior to the date of this notice shall be deemed abandoned unless timely renewed in compliance with the guidelines as set out above. Mediation of this matter pursuant to Section 120.573, Florida Statutes, is not available. No Department attorney will discuss this matter with you until the response has been received by the Department. DATED and SIGNED this [3% day of 19 STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF LEGAL SERVICES IN THE MATTER OF: GLOBAL MORTUARY CASE NO.: 122746-12-FC (License Number: F03991 1), ELECTION OF PROCEEDING I have received and have read the Administrative Complaint filed by the Florida Department of Financial Services ("Department") against me, including the Notice of Rights contained therein, and I understand my options, I am requesting disposition of this matter as indicated below. (CHOOSE ONE) Lt] 3.0] I do not dispute any of the Department’s factual allegations and I do not desire a hearing, I understand that by waiving my right to a hearing, the Board of Funeral, Cemetery and Consumer Services (“Board”) may enter a final order that adopts the Administrative Complaint and imposes the sanctions sought, including suspending or revoking my license(s) as may be appropriate, I do not dispute any of the Department's factual allegations and I hereby elect a proceeding to be conducted in accordance with Sections 120.57(2) and 497.153(4)(b), Florida Statutes, In this regard, I desire to: [] Submit a written statement and documentary evidence to the Board in lieu of a hearing; or {] Personally attend a hearing conducted by the Board at the location of a regularly scheduled Board meeting. I do dispute one or more of the Department's factual. allegations, I hereby request a hearing pursuant to Section 120,57(1), Florida Statutes, to be held before the Division of Administrative Hearings. I have attached to this election form the information required by Rule 28-106.2015, Florida Administrative Code, as specified in subparagraph (c) of the Notice of Rights. Specifically, I have identified the disputed issues of material fact in the response attached hereto, TO PRESERVE YOUR RIGHT TO A HEARING, YOU MUST FILE YOUR RESPONSE WITH THE DEPARTMENT OF FINANCIAL SERVICES WITHIN TWENTY-ONE (21) DAYS OF YOUR RECEIPT OF THE ADMINISTRATIVE COMPLAINT, THE RESPONSE MUST BE RECEIVED BY THE DEPARTMENT NO LATER THAN 5:00 P.M. ON THE TWENTY-FIRST DAY AFTER YOUR RECEIPT OF THE ADMINISTRATIVE COMPLAINT. The address for filing is: DFS Agency Clerk, Julie Jones, Florida Department of Financial Services, 612 Larson Building, 200 East Gaines Street, Tallahassee, Florida 32399-0390. Signature Print Name Date: Address: Date Administrative Complaint Received: If you are represented by an attorney or qualified Phone No.: representative, please attach to this election form his or her name, address, telephone and fax numbers Fax No.: 20 CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT and ELECTION OF PROCEEDING FORM has been furnished by U.S. Certified Mail, teturn receipt requested this /3 day of Novem ber _, 2012, to: GLOBAL MORTUARY 7210 ULMERTON ROAD SUITE J LARGO, FL 33771, * Florida Department of Financial Services 200 E. Gaines St., 6"" Floor Tallahassee, FL 32399-0390 Phone (850) 413-4230 Fax: (850) 488-0697 Counsel for the Department 24

Docket for Case No: 13-000404