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Form Ca 16

Form Ca 16

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__________________________________________________________ Contact Person: _______________________ Telephone Number: ( ) __________________ PLEASE USE CURRENT DATA TO RESPOND TO THIS SURVEY 1. ___ Enter the number of facilities currently licensed and pending licensure under your corporate name for this group home program. 2. ___ Enter the number of facilities owned by the corporation for which the corporation has clear title or has a mortgage/deed of trust. 3. ___ Enter the number of...
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