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Get MI LARA/SUB-500 2013-2024

N FOR A SUBSTANCE ABUSE PROGRAM LICENSE LARA/SUB-500 (5/13) FOR OFFICE USE ONLY MASTER SITE SATELLITE LOCATION INITIAL RENEWAL LICENSE NUMBER: ______________________ CA NUMBER: ___________________________ CONSULTANT: __________________________ DATE DUE: _____________________________ Mail a copy of this Application to the Regional Coordinating Agency listed on page 9 which corresponds with the program address. Pages 9 – 13 are instructions and do not need to be submitted with the applicatio.

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