Get Po Box 2568

Filling out the PO Box 2568 form online is a straightforward process that ensures your application is submitted accurately and efficiently. This guide provides step-by-step instructions to help you complete each section with confidence.

Follow the steps to effectively complete the PO Box 2568 form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Enter the purchasing organization information in Part I. Include the name of the organization, facility name, SHPDA ID number, address, city, state, zip code, number/type of licensed beds, and names of owners and operators.
3. Complete Part II with the selling organization information. Provide the name, address, city, state, zip code, number/type of licensed beds, along with the names of the owners and operators.
4. In Part III, specify the monetary value of the purchase and the terms of purchase.
5. Proceed to Part IV, listing the certificate of need authority, the number of beds, types of institutional health services, and service areas by county for home health agencies.
6. On an attached sheet, address the financial scope of the project, services offered, whether new beds will be added, if there will be a conversion of beds, and the acquisition of assets.
7. In Part V, certify the information provided, include signatures from the seller and purchaser, and the date.
8. Finally, review your entries for accuracy, save changes, and download or print the completed form.

Start filling out your PO Box 2568 form online today!