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Notice of Completed Closure A S S I S T E D L I V IN G P R O V ID E Instructions This form will (1) notify the commissioner, in writing, that the licensee completed the closure and (2) verify to the

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How to fill out notice of completed closure

01

Fill in the date of closure at the top of the form.

02

Provide the name and address of the individual or entity that is closing the account or project.

03

Include any relevant account or project details, such as account numbers or project names.

04

Sign and date the form to certify that the closure is complete.

Who needs notice of completed closure?

01

Businesses closing an account or project

02

Individuals closing an account or project

03

Government agencies or departments closing a project

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What is notice of completed closure?

The notice of completed closure is a document that signifies the completion of a closure activity for a particular project or facility.

Who is required to file notice of completed closure?

The responsible party or entity overseeing the closure activity is required to file the notice of completed closure.

How to fill out notice of completed closure?

The notice of completed closure form must be filled out with all relevant information regarding the closure activity, including dates, contact information, and any necessary certifications.

What is the purpose of notice of completed closure?

The purpose of the notice of completed closure is to inform regulatory agencies and stakeholders that a closure activity has been successfully completed in compliance with regulations.

What information must be reported on notice of completed closure?

The notice of completed closure must include details such as the location of the closure activity, the type of closure conducted, confirmation of necessary permits and approvals, and any post-closure monitoring plans.

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