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FOR BHF USELL1
2015
STATE OF ILLINOIS
DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
FINANCIAL AND STATISTICAL REPORT (COST REPORT)
FOR LONGER CARE FACILITIES
(FISCAL YEAR 2015)I.DPH License ID Number:
Facility
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Step 1: Start by gathering all the necessary information required to fill out the address form. This may include the recipient's name, street number, street name, apartment number (if applicable), city, state, and zip code.
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Step 2: Begin by writing the recipient's name on the first line of the address form.
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Step 3: Write the street number and street name on the second line, separated by a space. In this case, write '3222 Independence Dr'.
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Step 4: If there is an apartment number, write it on the third line after the street name.
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Step 5: On the fourth line, write the name of the city.
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Step 6: On the fifth line, write the name of the state.
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Step 7: On the last line, write the zip code.
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Step 9: Once you have filled out the address form completely, you can proceed to submit or use the address as needed.
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What is 3222 independence dr?
3222 independence dr is an address located at 3222 Independence Drive.
Who is required to file 3222 independence dr?
The entity or individual to whom the property at 3222 Independence Drive is registered is required to file.
How to fill out 3222 independence dr?
To fill out 3222 independence dr, you will need to provide information about the property at 3222 Independence Drive as requested on the form.
What is the purpose of 3222 independence dr?
The purpose of 3222 independence dr is to collect information about the property located at 3222 Independence Drive for record-keeping and tax purposes.
What information must be reported on 3222 independence dr?
Information such as the owner's name, address, property details, and any relevant tax information must be reported on 3222 independence dr.
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