Ifsubmittingmultiple changes to a license that fall under both A and Bbelow, the application fee is $100 for each license. American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com NOTE: Change of Ownership:A transfer of beneficial interest in the facility licensed by the board, in a single transaction or in a series of transactions, to any person or entity, which transfer results inthe transferee222s holding 50% or moreof the beneficial interestin the licensed facility shall complete the appropriate licensing application and submit all required documents as instructed in a change of ownership application. All approved changeof ownershipapplications result in anew license numberbeing issued. American LegalNet, Inc. www.FormsWorkFlow.com Under penalty of perjury, under the laws of the state of California, each person whose signature appears below, certifies and says: (1) He/she is the applicant, or one of the officers, partners, members, or majority owner of the applicant named in the foregoing application, duly authorized to make this application on its behalf; (2) that he/she has read the foregoing application and knows the contents thereof and that each and all statements therein made are true; (3) that no person other than the applicant or applicants has any direct or indirect interest in the applicant222s or applicants222 business to be conducted under the license(s) for which this application is made; and (4)all supplemental statements are true andaccurate American LegalNet, Inc. www.FormsWorkFlow.com