Lic 9040 Form PDF Details

The Lic 9040 form is a state-level business license application form used by businesses in the state of California. The form is used to apply for a variety of different business licenses, including those related to alcohol sales, food service, and other types of business activity. The Lic 9040 form must be completed and submitted to the appropriate government agency in order to receive a business license. The Lic 9040 form can be downloaded from the website of the California Secretary of State. Completed applications can be mailed or faxed to the address or number listed on the form. More information about specific licenses and how to apply for them can be found on the website of the relevant government agency.

Below is the details relating to the file you were in search of to complete. It will show you the amount of time you will need to finish lic 9040 form, what fields you need to fill in and several additional specific details.

QuestionAnswer
Form NameLic 9040 Form
Form Length1 pages
Fillable?Yes
Fillable fields73
Avg. time to fill out14 min 51 sec
Other nameslic 9040 forms california, fill lisc9040, lic lic 9040, lic 9040 form pdf

Form Preview Example

STATE OF CALIFORNIA—HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

CHILD CARE FACILITY ROSTER (RETAIN FOR 3 YEARS)

CHILD CARE CENTERS, INFANT CARE CENTERS, SCHOOL AGE CENTERS AND FAMILY CHILD CARE HOMES

NOTE: This roster must be kept in a central location at the facility, updated as needed and made available to the licensing agency upon request.

Health and Safety Code Section 1596.841 requires that each child care facility maintain a current roster of children who are provided care in the facility. The roster shall include the child’s name, address, names and day phone numbers of the parent(s) or guardian(s) and name and phone number of the child’s physician. This is an optional form that may be used for this purpose.

FACILITY NAME:

FACILITY LICENSE NUMBER:

DATE/UPDATE:

CHILD’S NAME/

BIRTHDATE

ADDRESS

PARENT/GUARDIAN

NAME(S)

DAYTIME PHONE OF PARENT/GUARDIAN

PHYSICIAN NAME

AND PHONE

DATE

ENROLLED

DATE LEFT

LIC 9040 (10/05)

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