ࡱ> %` V\bjbj"x"x 4|@@+ $$0p#####%&///////$W1h3*/]V)##V)V)/##[0***V)4##/*V)/***#d / ):*,,q000*5)5*5*Xo'h'J*!(<](o'o'o'//*o'o'o'0V)V)V)V)$$$$$$$$$$ OCFS-4939 (3/2010) NEW YORK STATE OFFICE OF CHILDREN AND FAMILY SERVICES PROVIDER NOTIFICATION OF LICENSING OR REGISTRATION TO FIRE AND POLICE OR SHERIFF DEPARTMENTS As a child day care provider you are required to give written notification concerning the location of your day care program to your local fire and police departments. If your local municipality does not have a fire or police department, the sheriff must be notified instead. This must be done within in five (5) days after receiving your license or registration. Keep a copy of the completed notification in your files and document where and when you sent the notice. You may be asked to provide proof of notification during the course of inspection of your day care program. If you have 911 in your community, you may also want to inform them. If there is any change in any of this information the appropriate local fire, police or sheriffs departments must be notified. COMPLETE THIS FORM AND SEND IT TO YOUR FIRE AND POLICE OR SHERIFF DEPARTMENTS This form may be copied Name of provider/program:  FORMTEXT      Address:  FORMTEXT      city/town:  FORMTEXT      zip code:  FORMTEXT      phone number (area code): (  FORMTEXT       )  FORMTEXT      I am (check one) FORMCHECKBOX  Day Care Center FORMCHECKBOX  School Age Program FORMCHECKBOX  Group Family Day Care Home FORMCHECKBOX  Family Day Care HomeI am licensed or registered to provide day care to a maximum of  FORMTEXT      children who range in age from  FORMTEXT      to  FORMTEXT      years of age. 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OCFS-4939\Provider Notification of Licensing or Registration to Fire and Police or Sherriff DepartmentgOCFS-4939; Provider Notification of Licensing or Registration to Fire and Police or Sherriff DepartmenttempusertempuserOh+'0T0     (4<DL OCFS-4939`Provider Notification of Licensing or Registration to Fire and Police or Sherriff Department tempuserhOCFS-4939; Provider Notification of Licensing or Registration to Fire and Police or Sherriff DepartmentOCFS-4939.dot tempuser1Microsoft Office Word@G@@3@^[ ՜.+,0 px   Day CareOCFS% '  OCFS-4939 Title  !"#$%&'()*+,-./0123456789:;<=>@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`acdefghijklmnopqrstuvwxyz{|~Root Entry FA Data ?TD1Tableb5WordDocument4|SummaryInformation(}DocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q