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Get OR SDS 0448B 2012-2024

On.) Co-applicant Resident manager Shift caregiver Part 1 ─ To be completed by licensee applicant 1 ― General information A. B. Applicant name: Phone: C. Adult Foster Home (AFH) address: Applicant’s home phone Applicant’s cell number Street/City/State/ZIP code D. Mailing address (if different): Street/City/State/ZIP code E. Applicant’s email address: check if none Required for co-applicant F. Classification: Select the license classification you are requesting. Class 1 C.

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