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FOR OF USELL1
2003STATE OF ILLINOIS
DEPARTMENT OF PUBLIC AID
FINANCIAL AND STATISTICAL REPORT FOR
LONGER CARE FACILITIES
(FISCAL YEAR 2003)I.DPH Facility ID Number:
Facility Name:0038505II.CERTIFICATION
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What is ninth street place?
Ninth Street Place is a form that must be filed by certain entities who conduct business in specified locations.
Who is required to file ninth street place?
Business entities who operate in designated areas are required to file Ninth Street Place.
How to fill out ninth street place?
Ninth Street Place can be filled out online or submitted in person at the specified office.
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The purpose of Ninth Street Place is to track and document business activities in specific locations.
What information must be reported on ninth street place?
Information such as business name, address, nature of business, and duration of operation must be reported on Ninth Street Place.
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