Assisted Living Application for Licensure

A check or money order for the required licensure fee made payable to ARKANSAS DEPARTMENT OF HUMAN SERVICES must accompany this submission except for those facilities operated by the State. Licensure Fee: $10.00 per bed. 1 4 DMS-803 (01/13) Page 4 of 4. DMS-803 (01/13) Page 1 of 4. For State Use Only [ ] Original [ ] Renewal ................
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