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PRINTED: 06/13/2019 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION A.

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What is anns house?

Anns house is a property owned by Ann.

Who is required to file anns house?

Ann is required to file information about her house.

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Ann can fill out information about her house by providing details such as address, value, and ownership.

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The purpose of Ann's house is for her to live in or use as an investment property.

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Information such as address, value, ownership, and any income generated from the property must be reported on Ann's house.

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