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Get IN DoH App Change Ownership Residential Facility

An application should include the following forms and/or documentation: 1. State Form 8200, Application for License to Operate a Health Facility, with required attachments (State Form 8200 enclosed); 2. State Form 19733, Implementing Indiana Code 16-28-2-6 (enclosed); 3. Documentation of the applicant entity’s registration with the Indiana Secretary of State; 4. Internal Revenue Services (IRS) documentation - form SS-4 or comparable document from the IRS that reflects direct owner’s corpora.

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