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LIVING/SHARED HOUSING INITIAL LICENSE APPLICATION / / # of Ind Units/Res: / Total # of Units to be Licensed: Initial License #: Issue / Expiration dates: / Please address ALL questions and TYPE or PRINT your answers. If an item DOES NOT apply to your establishment, enter N/A. This form ( and all required attachments) must be completed, signed by the licensee, and sent to the address listed on page eight of this form. THE ENTIRE APPLICATION/LICENSURE PROCESS CANNOT BE LONGER THAN SIX (6).

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