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Get WI F-62380 2015-2024

ON • Completion of this form is required per Wis. Stat. § Chapter 50.034(1) and Wis. Admin. Code § DHS 89.53, for certification, or Wis. Admin. Code § DHS 89.42, for registration, as a Residential Care Apartment Complex. NOTE: The licensee is responsible for notifying the Division of Quality Assurance in writing of any change in the information provided on this application. • Failure to complete this form accurately may result in a delay in processing or certification denial. • Sen.

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