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How to fill out the 19 13 D105 L 2 online
The 19 13 D105 L 2 form is essential for those seeking to operate assisted living services in Connecticut. This guide provides step-by-step instructions on filling out this form online to ensure compliance with state regulations and streamline the licensing process.
Follow the steps to complete the 19 13 D105 L 2 form online.
- Press the ‘Get Form’ button to access the 19 13 D105 L 2 online form. This will allow you to open the document in your web editor.
- Begin by entering the name and address of the assisted living services agency. Ensure that the information is accurate and corresponds with your records.
- Provide the names and addresses of all owners and controlling individuals of the agency. This should include anyone with a ten percent or greater ownership stake.
- Complete the section detailing the services your agency will provide. Be specific about assisted living services and any additional support offered.
- Include proof of financial viability by attaching a projected two-year budget. This should reflect estimated income and expenditures related to your agency’s operations.
- Attach your agency’s certificate of malpractice and public liability insurance as required. This documentation will solidify your application.
- Review all provided information to ensure it is complete and correct, then sign the application electronically.
- Submit the completed form online. After submission, you may download and save a copy for your records.
Complete the 19 13 D105 L 2 form online today to facilitate your licensed operation in assisted living services.
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