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Get Certificate No. -vsp - - State Of Indiana - In
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How to fill out the Certificate No. -VSP - - State Of Indiana - In online
This guide provides clear instructions on how to complete the Certificate No. -VSP - - State Of Indiana - In form online. By following the steps outlined below, users can efficiently fill out the application for a Certificate of Franchise Authority to provide video service in Indiana.
Follow the steps to fill out the form correctly.
- Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
- Start by entering the certificate number in the designated field. This number is vital for processing your application.
- Fill in the applicant's legal name as it is registered. Ensure that this name matches the official records to avoid delays.
- Provide any assumed names under which the applicant will operate. Remember, these names must be registered with the Secretary of State of Indiana.
- Complete the section for the authorized company representative or legal counsel. This includes their name, title, address, telephone, fax, and email address.
- List the contact for ongoing communication about this application, including their name, title, address, telephone, and email.
- Detail the principal place of business, including city, state, street address, and zip code.
- Enter the toll-free customer service telephone number(s) for assistance.
- List the names and titles of the principal officers involved in the organization, detailing their roles.
- If applicable, provide the parent company's legal name, title, address, and contact details.
- Specify the types of technology that will be used to deploy the video service. List each technology relevant to your service areas.
- Describe the types of video programming you will provide, including service levels.
- Provide a detailed description of the designated service area in Indiana for which you are seeking authority, including county lines, township lines, and areas to be served.
- State the expected date for deployment of video service in the designated service area.
- Indicate if any local franchises will be terminated with this application and provide the necessary attachments as required.
- List all other states where the applicant or its affiliates provide video service.
- Describe the process used to resolve customer complaints or disputes.
- Complete the affidavit section, ensuring all facts stated in the application are correct and that you have the authority to bind the applicant.
- Once all sections are completed, review the application for accuracy before saving your changes, downloading, printing, or sharing it.
Take the next step towards managing your application — complete your documents online today.
Indiana requires CONs within two broad categories—beds outside hospitals and facilities. The program regulates only nursing homes. It also has the distinction of being the newest in the country.
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