Are you a first-time entrepreneur who is looking to start up their business? Or perhaps an existing business owner in need of some guidance with filling out the necessary forms and paperwork? Whichever category you fall into, it’s important to be aware of what documents are available to help advance your enterprise. One of these essential forms is the SCR 1 Form, which stands for Statement by Corporator Resigning from Office. This document plays an integral role in forming corporations both large and small. In this blog post, we will discuss everything there is to know about completing this form correctly and efficiently so that your business operations become as smooth-sailing as possible.
| Question | Answer |
|---|---|
| Form Name | Scr 1 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | Applicant, louisiana state registry form, mandated, SCR |
SCR 1 Issued 01/10
STATE OF LOUISIANA |
1/10version |
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DEPARTMENT OF SOCIAL SERVICES |
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STATE CENTRAL REGISTRY DISCLOSURE FORM |
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This form must be completed by each individual owner, operator, current or prospective employee or volunteer of a child care facility licensed by the Louisiana Department of Social Services for themselves. Any owner, operator, current or prospective employee, or volunteer of a child care facility licensed by the department who knowingly falsifies the information on the State Central Registry Disclosure Form shall be guilty of a misdemeanor offense and shall be fined not more than five hundred dollars, or imprisoned for not more than six months, or both. R.S. 46:1414.1.C
This form shall be maintained by the owner/operator of the licensed facility in accordance with current licensing standards as mandated by R.S. 46:1414.1.B.
Name of Licensed Facility (Print or Type)
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License Number and Physical Address (print or |
Date Signed |
Type) |
Form Received |
Name of Individual or Applicant (Print or Type)
Street Address |
Date of Birth |
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( |
) - |
( |
) - |
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Home Ph. # |
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Cell Ph. # |
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Social Security |
City and State |
Zip Code |
Number |
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My name
is |
is not |
currently recorded as a perpetrator on the State Central Registry for what the Department of |
(check one) |
Social Services has determined to be a justified (valid) finding of child abuse or neglect. |
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If it is determined that I do pose a risk to children, I am prohibited from requesting another risk evaluation assessment for 24 months from the date of this notice.
The information given is true and complete to the best of my knowledge.
Signature |
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Date |
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Signature of Licensed Facility Representative |
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Date |
DSS Office Use Only
Name of Regional Administrator or designee:
Date State Central Registry Check Completed:
Date Reviewed:
Date of notification of results to Child Residential Licensing or Child Care Licensing: