INSTRUCTIONS - Texas Health and Human Services
Attach a copy of Assumed Name Certificate . If an Applicant has a Parent Organization, attach a copy of the agreement between the Applicant and the Parent Organization . Type of Applicant – Check appropriate box(es) and attach documentation as indicated. Sole Proprietorship . Private Corporation. For Profit. Non-Profit. State of Incorporation: Charter Number: Attach a copy of Certificate of ... ................
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