Business License Application
Business Status
| What would you like to do today: |
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Business Name and Physical Location
| Business Name or Trade Name |
Contracted respite provider
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| Business Street Address (Physical location of the business cannot be a PO Box) |
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| Mailing Address (Street name and number only) |
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| Mailing Address City, State, & Zip Code |
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| Business Phone Number |
+19286428570
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| Number of Employees |
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| Please read through the list carefully and select the closest description of your business: |
HOME OCCUPANCY SERVICES
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| Start of business date |
2025-04-14
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| is the business location: |
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| Nature of Ownership |
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Federal Tax ID or Social Security Number
| Please provide your Federal ID or Social Security Number |
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Professional Licenses
| Upload File |
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| Professional License or Permit Number & Description |
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