Succession Plan 2024

Please complete this form to place your order.


Your plan will be delivered via email as quickly as we are able to complete it.

Instructions

The following information will be needed to complete your plan. Take your time to gather all of the information before submitting this form.


You will be choosing a successor/designee to handle the affairs of your facility in event of your incapacitation or death. The successor/designee you name must agree to the arrangement according CDSS regulations. A notarized agreement will be required. Find a notary that can assist you in completing the final document before sending to licensing.


Please note the following:

  • Do not use "ALL CAPS" or "all lower-case" when completing the form.
  • Corrections due to misspellings or inaccurate information may result in additional charges up to $50.
  • Email delivery can be expected by the end of the next business day, but please allow us up to three days.
  • Printed copies can be purchased for $25.

Please note: We check orders daily but may need up to 3 days to complete your plan.

Your company name (as licensing recognizes you)

ONLY ONE FACILITY PER ORDER

Select
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Choose what action you plan to take in the event of licensee death or incapacitation.

Select
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The name of the individual acting as the successor.

THIS CANNOT BE THE SAME AS THE LICENSEE

Nine digit number - Please include the "0" if it is the first number.

ONLY ONE FACILITY PER ORDER

Please verify before providing this information. Some Licensing Office assignments have recently changed.

Phone
Phone


Payment & Contact Information

Select or enter value
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Select or enter value
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3 or 4 digit code on back or corner of the card

Phone

Thank you for your order!