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Type of limited Adult Foster Home (AFH) license requested: New Renewal 1 ─ General information A. Applicant’s name: B. Applicant’s date of birth: C. Phone: check if none Applicant home phone Applicant cell phone D. AFH address: Street City/state/ZIP code E. Mailing address (if different): F. Applicant’s email address: check if none 2 ─ Applicant information A. Are you now, or have ... ................
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