Continuing Care of Maryland Department of Aging Application for Renewal Certificate of Registration Fiscal Year End Date: Date Submitted: COMAR Title 32.02.01.13 fully states requirements for information to be submitted when applying for a Renewal Certificate of Registration. Name of Community: Chief Executive Officer: 1. Street Address (mailing): City/State/Zip Code: Telephone Number: Email Address: Executive Director or Manager: Street Address (mailing): 2. City/State/Zip Code: Telephone Number: Address: Financial Officer: Street Address (mailing): 3. City/State/Zip Code: Telephone Number: Email Address: Resident Association President Street Address (mailing): 4. City/State/Zip Code: Telephone Number: Email Address: Name of any affiliate, parent or subsidiary 5. Person as defined in Title 10-401 (G) and (Q): Street Address (mailing):
of Maryland Department of Aging Continuing Care Application for Renewal Certificate of Registration Fiscal Year End Date: Date Submitted: COMAR Title 32.02.01.13 fully states requirements for information to be submitted when applying for a Renewal Certificate of Registration. 1. Name of Community: Chief Executive Officer: Street Address (mailing): City/State/Zip Code: Telephone Number: Email Address: 2. Executive Director or Manager: Street Address (mailing): City/State/Zip Code: Telephone Number: Address: 3. Financial Officer: Street Address (mailing): City/State/Zip Code: Telephone Number: Email Address: 4. Resident Association President Street Address (mailing): City/State/Zip Code: Telephone Number: Email Address: 5. Name of any affiliate, parent or subsidiary Person as defined in Title 10-401 (G) and (Q): Street Address (mailing):
ApplicationRenewalCert02022017.docx