Link to State of North Dakota

 

Fire Safety Self Declaration, SFN 800 660-05-65-20

(Revised 5/1/19 ML 3549)

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This form is required for both an initial license and to renew a license.  

 

It is the responsibility of the applicant or provider to complete this form and submit it to the County Social Service Agency. A copy of this form must be sent to the Aging Services Division.

 

An electronic copy of this form may be obtained at http://www.nd.gov/eforms/.

 

 

 

 

 

 

 

 

 

 

 

 

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