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Get CT Public Health Form FLIS LICAPP-001 2006-2024

[ ] Trust Limited Partnership [ ] Profit Corporation Limited Liability Company Other: __________________________________ Non-profit Corporation 6. Is the above named entity authorized by the Office of the Secretary of State to transact business in the State of Connecticut and considered in Good Standing? [ ] YES [ ] NO 7. Please disclose the name, business address and telephone number of the Agent for Service for the Licensee. ________________________________________________________________.

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