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STATE OF NEW HAMPSHIRE BOARD OF REGISTRATION OF FUNERAL DIRECTORS AND EMBALMERS 121 South Fruit St. Suite 303 Concord NH 03301-2412 603 271-4648 FAX 603 271-5056 APPRENTICE EMBALMING FORM Please Print or Type Apprentice Unassisted Report No. Assisted Report No. Current Apprenticeship License period from to Name of Apprentice Apprentice Lic. No. First Last Name of Licensed Sponsor License No. Name and Location of Funeral Home Deceased Name Date of Birth Address Place of Death Date of Death...

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