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InetrucNon� la Ori �in� or --�- <br />r--�� �,i n,, r, S1 �jl �� �!; i <br />i t� ThI� fonn H(d be u�ed v� nesipt ol m�ppActlion fa � dq c�ro c�nbr, mini-dq e�n c�nter, or proup uro faeflily la <br />. �. � children. �.� <br />' . �` �� ��;�� <br />2. M Is�imniCsssery to uss this lorm lor reBcensln0 unlsu thNe i� d�o � ch�npe ol �dArsa� !or tAa hcllity. <br />- ��� <br />3. One qopy? W 1he'oompljtd�, fprm ehdl ba forw�rded ro tM �ppropri�te Iocai pl�nNnp/xonlnp �pen�y, ons to tAs applicant, <br />:�nd+olw eddy ah�ll be pl�cW in ths licendnp fils. <br />1. For day ��ro centere e copy eh�ll �Iso bs lorw�rded to: <br />Chtal BWler Intpecta <br />Dep�rtmant ot Lebor end Industriss <br />300 West Hertison, Room 608 <br />Se�tNe, WuAlnpton 98it9 <br />DSNS �s.�ES (Rn drlSl Ma oK �.ao <br />' �. <br />