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Y Homes, Small Family Homes, Certified Family Homes Complete both pages and sign on page 2. I. OUT-OF-STATE DISCLOSURE Foster Family Homes, Small Family Homes, Certified Family Homes, and approved homes at time of application only Have you lived in a state other than California within the last five years? If YES, identify each state and complete an LIC 198B for each state listed: YES NO II. CRIMINAL RECORD STATEMENT Foster Family Homes, Small Family Homes, Certified Family Homes S.

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