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  • Facility As Authorized Representative Dhs 222 10.08. Dhs 222. 10.08

Get Facility As Authorized Representative Dhs 222 10.08. Dhs 222. 10.08

Case name: Branch: Organization name: Address: Authorized representative name: File: Responsibilities and Liabilities for Facility orTreatment Center and Group Living Arrangements (GLA) Acting.

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Answer: Someone (officer, owner, etc.) with authority to make decisions for the company.

An applicant or licensee may give a representative authorization to make changes to the license; sign application forms on behalf of the licensee or applicant; or receive information about a license or application. The applicant or licensee may use this form to document that authorization.

Using Authorized Representatives An authorized representative can be any member of the general public (see exception regarding employees below), personnel officer, foreman, agent, or notary public where permissible.

(Failure to complete this form in its entirety will invalidate this authorization) An Authorized Representative is a person you authorize to act on your behalf, in pursuing a claim or an appeal of a denied claim.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232