Lic 610E Form California Details

The Lic 610E form is an important document for businesses in New York State. This form is used to apply for a Business Certificate and to register with the Tax Department. The Tax Department uses this information to determine a business's tax liability. Filing this form correctly is critical, so make sure you are familiar with the requirements. For more information, consult the instructions provided by the Tax Department.

Below are some specifics of lic 610e form. You can read it before typing in the gaps.

QuestionAnswer
Form NameLic 610E Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameslic 610 rcfe, california lic 610e, lic610e, lic 610e form california

Form Preview Example

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

EMERGENCY DISASTER PLAN FOR RESIDENTIAL CARE FACILITIES FOR THE ELDERLY

INSTRUCTIONS:

Post a copy in a prominent location in facility, near telephone.

Licensee is responsible for updating information annually. Return a copy to the licensing office.

NAME OF FACILITY

ADMINISTRATOR OF FACILITY

FACILITY ADDRESS (NUMBER, STREET,

CITY,

STATE,

ZIP CODE)

TELEPHONE NUMBER

( )

FAX NUMBER

( )

CELL PHONE NUMBER

( )

I.ASSIGNMENTS DURING AN EMERGENCY (USE REVERSE SIDE IF ADDITIONAL SPACE IS REQUIRED)

 

NAME(S) OF STAFF

TITLE

ASSIGNMENT

 

1.

 

DIRECT EVACUATION AND PERSON COUNT

 

 

 

 

 

 

2.

 

HANDLE FIRST AID

 

 

 

 

 

 

3.

 

TELEPHONE EMERGENCY NUMBERS

 

 

 

 

 

4.

 

TRANSPORTATION

 

 

 

 

 

5.

 

NOTIFY FAMILY MEMBERS

 

 

 

 

 

6.

 

NOTIFY CCL AND OTHER AGENCIES

 

 

 

 

 

 

II.EMERGENCY NAMES AND TELEPHONE NUMBERS (IN ADDITION TO 9-1-1)

FIRE/PARAMEDICS

POLICE OR SHERIFF

RED CROSS

OFFICE OF EMERGENCY SERVICES

PHYSICIAN(S)

POISON CONTROL

HOSPITAL(S)

AMBULANCE

DENTIST(S)

ADULT PROTECTIVE SERVICES

LONG TERM OMBUDSMAN

OTHER AGENCY/PERSON

COUNTY MENTAL HEALTH

III. FACILITY EXIT LOCATIONS (USING A COPY OF THE FACILITY SKETCH [LIC 999] INDICATE EXITS BY NUMBER)

1.

3.

2.

4.

IV. TEMPORARY RELOCATION SITE(S) (IF AVAILABLE, SUBMIT LETTER OF PERMISSION FROM RENTER/LEASEE/MANAGER/PROPERTY OWNER)

NAME

ADDRESS

TELEPHONE NUMBER

 

 

(

)

 

 

 

NAME

ADDRESS

TELEPHONE NUMBER

 

 

(

)

V.UTILITY SHUT—OFF LOCATIONS (INDICATE LOCATION(S) ON THE FACILITY SKETCH [LIC 999])

ELECTRICITY

WATER

GAS

VI. FIRST AID KIT (LOCATION)

VII. AED (IF AVAILABLE - LOCATION)

VIII. EQUIPMENT

SMOKE DETECTOR LOCATION

FIRE EXTINGUISHER LOCATION

TYPE OF FIRE ALARM SOUNDING DEVICE (IF REQUIRED)

LOCATION OF DEVICE

IX. AFFIRMATION STATEMENT

AS ADMINISTRATOR OF THIS FACILITY, I ASSUME RESPONSIBILITY FOR THIS PLAN FOR PROVIDING EMERGENCY SERVICES AS INDICATED BELOW. I SHALL INSTRUCT ALL CLIENTS/RESIDENTS, AGE AND ABILITIES PERMITTING, ANY STAFF AND/OR HOUSEHOLD MEMBERS AS NEEDED IN THEIR DUTIES AND RESPONSIBILITIES UNDER THIS PLAN.

SIGNATURE

DATE

LIC 610E (10/03) (PUBLIC)

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