ࡱ> @ bjbjFF (,,[FsTTT$x@K@K@KPKTLxt:dNQ(6Q6Q6QSU4W~~~~L~$RTWS^SWW6Q6QO.[[[WvR6QT6Q~[W~[[scP2"TSs6QXN 0ٷ@K1X^r~t D0tAsX$SsxxTSsL[WWWxx.4$[(xx4 STATE OF SOUTH CAROLINA DEPARTMENT OF CONSUMER AFFAIRS APPLICATION FOR A CONTINUING CARE RETIREMENT COMMUNITY LICENSE (RENEWAL) S.C. Code Ann. 37-11-10 through 37-11-140 (Supp. 1997)  HYPERLINK "http://www.state.sc.us/consumer" www.state.sc.us/consumer 803-734-4236/800-922-1594 Date submitted:  FORMTEXT      1.Name of Facility FORMTEXT      Street Address FORMTEXT      Mailing Address FORMTEXT      City/State/Zip FORMTEXT      Telephone No. FORMTEXT      Fax No. FORMTEXT      2.Name of OperatorStreet Address FORMTEXT      Mailing Address FORMTEXT      Telephone No. FORMTEXT      Fax No. FORMTEXT      3.The operator is Partnership FORMCHECKBOX Limited Partnership FORMCHECKBOX (Check One)Corporation FORMCHECKBOX Other FORMCHECKBOX Specify:  FORMTEXT      4.Chief Executive Officer FORMTEXT      Street Address FORMTEXT      Mailing Address FORMTEXT      City/State/Zip FORMTEXT      Telephone No. FORMTEXT      Fax No. FORMTEXT      5.Name of affiliated parent or subsidiary corporation or partnership  FORMTEXT      Street Address FORMTEXT      Mailing Address FORMTEXT      Telephone No. FORMTEXT      Fax No. FORMTEXT      6.Owner s Name (Indicate if individual, partnership, corporation, unincorporated association, etc.)  FORMTEXT      Street Address FORMTEXT      Mailing Address FORMTEXT      Telephone No. FORMTEXT      Fax No. FORMTEXT      7.Name of person to contact in case of inquiries  FORMTEXT      Position within facility FORMTEXT      Street Address FORMTEXT      Mailing Address FORMTEXT      Telephone No. FORMTEXT      Fax No. FORMTEXT      NOTE:ALL EXHIBITS LISTED BELOW MUST BE ATTACHED. IF THE EXHIBIT(S) ARE NOT APPLICABLE OR AVAILABLE, ATTACH AN EXPLANATION IN PLACE OF THE REQUIRED EXHIBIT (S) STATING THE REASON (S) THEY ARE NOT APPLICABLE OR AVAILABLE.8.(Attach as Exhibit A) A description of any material change with respect to any information provided with the previous application. Please attach appropriate documentation.NOTE:Examples of material changes include, but are not limited to the following: Change in the corporate status, ownership interest, management, information provided under South Carolina Code Annotated 37-11-30 (B) (2), contracts, services provided, fees charged, (including entrance fees), and escrow agreements. Any questions or doubts should be resolved with the Staff of the Department of Consumer Affairs.)9.(Attach as Exhibit B) A statement concerning any litigation orders, judgments or decrees which might affect the facility.10.(Attach as Exhibit C) A statement of any changes that have occurred with respect to your admission and disclosure policies. If none occurred, please state so.11.(Attach as Exhibit D) The number of living units constructed and the current number of residents of the facility that are provided services pursuant to a contract for continuing care; the number of reservation agreements and/or the number of people on the waiting list; and, if applicable, a current occupancy status of a nursing home, community residential care facility, or a similar facility or accommodation.12.(Attach as Exhibit E) A copy of all written complaints handled through your facility's complaint system since your last application and a statement of the average time taken to resolve a complaint.13.(Attach as Exhibit F) A representative sample of advertisements for your facility since your last application.14.(Attach as Exhibit G) Copies of any DHEC license that you hold or a list of licenses for which you have applied. Please state specifically whether the DHEC license you have and/or have applied for are community based or restricted.15.(Attach as Exhibit H) A statement as to whether or not your facility or any component hereof is eligible for Medicare and/or Medicaid. In case the facility is not eligible for Medicare and/or Medicaid, insert also the following statement in bold face type in your disclosure statement:This facility is currently (not) eligible for (Medicare and/or Medicaid) (insert whichever is applicable). In case a resident exhausts his available financial resources prior to or following admission into our nursing home or assisted living accommodations, the resident might have no choice but to apply for admission to a facility that is eligible for these payments.16.(ATTACH IN SEPARATE BINDERS) A copy of a disclosure statement conforming in all respects to SC Code Ann. 37-11-60 and SC Code Regs. 28-600 O. This Exhibit shall be accompanied by an affidavit by the operator that prospective residents will or are receiving this disclosure statement.17.(ATTACH IN SEPARATE BINDERS)(a) Certified financial statements of the operator. The statements shall include a balance sheet as of the end of your most recent fiscal year and statements of income and expenses for your two most recent fiscal years or for all of the years in existence if less than three years. The statements shall be in accordance with generally accepted accounting principles and shall also contain the following:(i) an accountant's opinion; and(ii) notes to the financial statements considered customary or necessary to full disclosure or adequate understanding of the financial statements, financial condition, and operation.PLEASE NOTE9x̹zgUC4Chj5CJOJQJ]aJ"hH^:hj5CJOJQJ]aJ"hH^:hj5CJOJQJ\aJ%hH^:hj5>*CJOJQJ\aJ(jhH^:hjCJUaJmHnHu3jhj5>*CJOJQJU\aJmHnHuhjB*CJOJQJaJph%h?hjB*CJOJQJaJphhhjCJOJQJaJ0jhhjCJOJQJUaJmHnHuhjCJOJQJaJ 9g % & ' ( ) :  $pA$pA$L$L$L$L$L$L$4_$x5D55 $Ifgd65 $$Ifa$gdP $1$Ifgd65$$d %d N O a$gdj$d %d N O gdj: $ % & ' ( : ; E ҸzhdWK;KjhjCJOJQJUaJhjCJOJQJaJh65hjCJOJQJhj"hhj5CJOJQJ\aJ h`Z"hj0JCJOJQJaJ.jh`Z"hjCJOJQJU]aJ)h`Z"hj0J56CJOJQJ\aJ2jh`Z"hj0J56CJOJQJU\aJ)hj0J56:;CJOJQJ\aJ/hH^:hj0J56:;CJOJQJ\aJE F      0 > @ B V X Z d f h wkUw?w.!h]5h,=uB*CJOJQJph*jhCJOJQJUaJmHnHu+juhhCJOJQJUaJhCJOJQJaJjhCJOJQJUaJh65h,=uCJOJQJh,=uCJOJQJh65h,=uCJaJh,=uCJaJhjh65CJOJQJaJhz<hjCJOJQJhjCJOJQJaJjhjCJOJQJUaJ+jhhjCJOJQJUaJ     LtDLkbL $Ifgd65 $$Ifa$gdP $1$Ifgd65skd[$$Ifl4\,H%b %4 laf4   @ h hG 5~5 $Ifgd]5 $1$Ifgd65`kd$$Ifl4F,H%;%    4 laf4h j l 5 5~5 $Ifgd65 $Ifgd\`kd$$Ifl4Fh,%W%    4 laf4h j " 6 8 : D F H J L f ʴ֞{֑֞nX֑֞nNhr2CJOJQJ+jlhhCJOJQJUaJhz<hr2CJOJQJ+johhCJOJQJUaJhz<hr2CJOJQJ*jhCJOJQJUaJmHnHu+jrhhCJOJQJUaJhCJOJQJaJjhCJOJQJUaJhz<h,=uCJOJQJhz<h,=uCJOJQJ 5 5~5 $Ifgdr2 $Ifgd\`kd$$Ifl4Fh,%W%    4 laf4  H J 5 5~54`kd$$Ifl4Fh,%W%    4 laf4 $Ifgdr2`kd$$Ifl4Fh,%W%    4 laf4J L h 5 5~55 5~5`kd$$Ifl4Fh,%W%    4 laf4 $Ifgdr2f h j ~  㟒r㟒cVLhoCJOJQJh65hr2CJOJQJhjhr2CJOJQJaJ+jfhhCJOJQJUaJhr2CJOJQJhz<hr2CJOJQJhr2CJOJQJaJ*jhCJOJQJUaJmHnHu+jihhCJOJQJUaJhCJOJQJaJjhCJOJQJUaJhz<hr2CJOJQJ L~L>55 5 $Ifgdr2Mkdc$$Ifl40,%W%4 laf4 $Ifgd65 $Ifgd\`kd$$Ifl4Fh,%W%    4 laf4  H ~5 5~5 $Ifgd]5 $Ifgd\`kd$$Ifl4Fh,%W%    4 laf4 $Ifgdr2  " 6 8 : D F H J l n  ͷ١ٕr١ٕ\١ٕ+jY hhCJOJQJUaJ+j\ hhCJOJQJUaJhz<hoCJOJQJhoCJOJQJaJ*jhCJOJQJUaJmHnHu+j_ hhCJOJQJUaJhCJOJQJaJjhCJOJQJUaJhoCJOJQJhz<hoCJOJQJ!H J L l 5 5~5 $Ifgd]5 $Ifgd\`kd $$Ifl4Fh,%W%    4 laf4 5 5~5 $Ifgd]5 $Ifgd\`kd $$Ifl4Fh,%W%    4 laf4  5 5~5 $Ifgd]5 $Ifgd\`kd $$Ifl4Fh,%W%    4 laf4       F \ ^ ` | ~ ٷ{eY{CY+jhhCJOJQJUaJhr2CJOJQJaJ+j hhCJOJQJUaJhCJOJQJaJh#&3CJOJQJhr2CJOJQJhjhr2CJOJQJaJhz<hoCJOJQJhoCJOJQJaJ*jhCJOJQJUaJmHnHujhCJOJQJUaJ+jX hhCJOJQJUaJ    $ F ^ %LZQ5H5H555 $Ifgdr2 $Ifgd\:kdW $$Ifl4%%%4 laf4 $Ifgd]5`kd $$Ifl4Fh,%W%    4 laf4 5 5I@57L7 $Ifgdo $Ifgd\kd$$Ifl4֞h$ %p %4 laf4 $Ifgd]5 $&(68TVXnpʾʾʾʾʾ|fʾYJ@hoCJOJQJhjhoCJOJQJaJhz<hjCJOJQJ*jhjCJOJQJUaJmHnHu+jIhhjCJOJQJUaJ+jhhjCJOJQJUaJ+jahhjCJOJQJUaJhjCJOJQJaJjhjCJOJQJUaJh)jhjCJOJQJaJhjCJOJQJhz<hr2CJOJQJ*6Zn555`556kd$$Ifl4ִh$ %p8%    4 laf4 $Ifgd]5%L5 5~5Q5H 5 $Ifgdo`kd{$$Ifl4Fh,%W%    4 laf4 $Ifgd\:kd$$Ifl4%%%4 laf4 $Ifgd]5246@BDFhj~﫞q﫞[﫞+jhhCJOJQJUaJ+jhhCJOJQJUaJhz<hoCJOJQJhoCJOJQJhz<hoCJOJQJhoCJOJQJaJ*jhCJOJQJUaJmHnHu+jhhCJOJQJUaJhCJOJQJaJjhCJOJQJUaJDFHh~55 5~5 $Ifgdo $Ifgd\`kdz$$Ifl4Fh,%W%    4 laf4 $Ifgd]55 5~5 $Ifgd]5 $Ifgdo $Ifgd\`kdy$$Ifl4Fh,%W%    4 laf4 "$68LNPZ\^`dٷهqٷه[ٷLhjhoCJOJQJaJ+jhhCJOJQJUaJ+jhhCJOJQJUaJhCJOJQJaJhoCJOJQJhz<hoCJOJQJhz<hoCJOJQJhoCJOJQJaJ*jhCJOJQJUaJmHnHujhCJOJQJUaJ+jhhCJOJQJUaJ"5 5 $Ifgd]5 $Ifgdo $Ifgd\`kdx$$Ifl4Fh,%W%    4 laf4"$&6^5 5~5 $Ifgd]5 $Ifgdo $Ifgd\`kdw$$Ifl4Fh,%W%    4 laf4^`bdj%LZQ5H 5H~5H~5 $Ifgdo $Ifgd65:kd$$Ifl4%%%4 laf4 $Ifgd]5`kdv$$Ifl4Fh,%W%    4 laf4  :<>RTV`bdfﭠ}q[q+jLhhCJOJQJUaJhoCJOJQJaJ+jMhhCJOJQJUaJhz<hoCJOJQJhz<hoCJOJQJhoCJOJQJ*jhCJOJQJUaJmHnHu+jNhhCJOJQJUaJhCJOJQJaJjhCJOJQJUaJ!<df5 5~54`kd$$Ifl4Fh,%W%    4 laf4 $Ifgd7*`kd$$Ifl4Fh,%W%    4 laf4fh5 5~55 5~5`kd$$Ifl4Fh,%W%    4 laf4 $Ifgdo $Ifgd7* "$&0246:<>@Zٷٔ~ٷo`TEETETETh)jhoCJOJQJaJhoCJOJQJaJhzjhoCJOJQJaJhjhoCJOJQJaJ+jJhhCJOJQJUaJhCJOJQJaJhoCJOJQJhz<hoCJOJQJhoCJOJQJaJ*jhCJOJQJUaJmHnHujhCJOJQJUaJ+jKhhCJOJQJUaJ 45~5 $Ifgdo $Ifgd7*`kd$$Ifl4Fh,%W%    4 laf4468:@  4%LZQ5H $H~5H~5H~5 $Ifgdo $Ifgd\:kdI$$Ifl4%%%4 laf4 $Ifgd]5`kd$$Ifl4Fh,%W%    4 laf4 "$&02468TVXlnpz|~ɳ՝yc՝yM՝+jhhCJOJQJUaJ+jhhCJOJQJUaJhz<hoCJOJQJhoCJOJQJhz<hoCJOJQJ*jhCJOJQJUaJmHnHu+jhhCJOJQJUaJhCJOJQJaJjhCJOJQJUaJhoCJOJQJaJh)jhoCJOJQJaJ468V~5 5~54`kd $$Ifl4Fh,%W%    4 laf4 $Ifgd7*`kd$$Ifl4Fh,%W%    4 laf45 5~55 5`kd $$Ifl4Fh,%W%    4 laf4 $Ifgd7*&(<>@JLNPTZͷ١ٕr١ٕcWha^CJOJQJaJhjhoCJOJQJaJ+j!hhCJOJQJUaJhz<hoCJOJQJhoCJOJQJaJ*jhCJOJQJUaJmHnHu+j hhCJOJQJUaJhCJOJQJaJjhCJOJQJUaJhoCJOJQJhz<hoCJOJQJ&NP5 5~54`kd "$$Ifl4Fh,%W%    4 laf4 $Ifgd7*`kd !$$Ifl4Fh,%W%    4 laf4PRTZ%L5 5~5~5 $Ifgdo $Ifgd\:kd"$$Ifl4%%%4 laf4 $Ifgd]5.02<>@BD`bdxٷوrٞe[N[وhz<hoCJOJQJhoCJOJQJhz<h 2{CJOJQJ+j$hhCJOJQJUaJhCJOJQJaJh 2{CJOJQJh 2{CJOJQJaJhz<hoCJOJQJhoCJOJQJaJ*jhCJOJQJUaJmHnHujhCJOJQJUaJ+j"hhCJOJQJUaJ@5| 5|~5 $Ifgdo $Ifgd\qkdX#$$Ifl4Fh,%W%    4 laf4p@BDb5| 5~5 $Ifgdo $Ifgdr2qkdx$$$Ifl4Fh,%W%    4 laf4pxz|  24Hٷهqٷه[ٷه+j 'hhCJOJQJUaJ+j!&hhCJOJQJUaJhCJOJQJaJhz<hoCJOJQJhoCJOJQJhz<hoCJOJQJhoCJOJQJaJ*jhCJOJQJUaJmHnHujhCJOJQJUaJ+j"%hhCJOJQJUaJ5 5~54`kd&$$Ifl4Fh,%W%    4 laf4 $Ifgdr2`kd%$$Ifl4Fh,%W%    4 laf4 "2Z5 55 5~5 $Ifgdw$`kd'$$Ifl4Fh,%W%    4 laf4 $Ifgdr2HJLVXZ\^`hjl  abٷobSF*CJOJQJhchcCJOJQJhcCJOJQJhchcCJaJhchc5\hc5CJOJQJUhchc5hchc5CJOJQJhz<hcCJOJQJhjhcCJOJQJaJhz<hNHCJOJQJhchNHCJOJQJ%%%%%<%LXJ5 $$1$Ifa$gd:kd6$$Ifl4%%%4 laf4 $1$Ifgdc`kd5$$Ifl4F%.* %    4 laf4IF THE FISCAL YEAR ENDED MORE THAN ONE HUNDRED TWENTY DAYS BEFORE THE DATE OF FILING, PLEASE SUBMIT YOUR PREVIOUS CERTIFIED FINANCIAL STATEMENT TOGETHER WITH AN UNCERTIFIED STATEMENT FOR THE PERIOD BETWEEN THE DATE THE FISCAL YEAR ENDED AND A DATE NOT MORE THAN NINETY DAYS BEFORE THE DATE THE APPLICATION IS FILED.(b) A projected annual budget of the facility for one year(c) If the facility had in the past two years a feasibility study made, please submit a copy of the study.(d) A statement of financial responsibility as required in SC Code Regs. 28-600 S.18.Any additional information that you may think is material may be attached and labeled as Addendum 1,2, etc.19.A check for $2,000 made payable to the South Carolina Department of Consumer Affairs.20.The undersigned attest that the information submitted herein is true and accurate. ____________________________________ Signature ____________________________________ Title ____________________________________ Signature ____________________________________ Title SWORN AND SUBSCRIBED to before me this ______ day of ____________, ______. ___________________________________ Notary Public for _____________________ My Commission Expires: _______________ PLEASE NOTE: THE APPLICATION FORM SHALL BE SIGNED BY THE CHIEF EXECUTIVE OFFICER OF THE FACILITY AND BY THE PERSON WHO PREPARED THE APPLICATION. PLEASE READ VERY CAREFULLY REGULATION R.28-600 I (ALL LICENSE APPLICATIONS, FORM) APPLICATIONS NOT FOLLOWING THE GUIDELINES OF THE REGULATION SHALL BE RETURNED TO THE OPERATOR. Renewal Application Revised 03/04 Page  PAGE 1 of  NUMPAGES 3 Street Address 3600 Forest Drive Columbia, SC 29204-4406 Mailing Address P.O. Box 5757 Columbia, SC 29250-5757 <=>?@ABWLLT!L<W5`kd6$$Ifl4FW%.,"%    4 laf4 $1$Ifgdc $Ifgd\MkdW6$$Ifl40%X %4 laf4BC~5T!5WLLT!L $Ifgd\`kd=7$$Ifl4FW%.,"%    4 laf4 $1$IfgdcW55T!5 $1$Ifgdc $Ifgd\`kd7$$Ifl4FW%.,"%    4 laf4WLXT!L $1$Ifgdc $Ifgd\`kd38$$Ifl4FW%.,"%    4 laf4JW5xT!x $1$Ifgdc $Ifgd\`kd8$$Ifl4FW%.,"%    4 laf4HIJKLMNQR¾ƾ $wxyz{|}ҿ׿ؿɼͥ͘th\h9CJOJQJaJhICJOJQJaJh~h9CJOJQJaJht 䐣@?| ,$^^rp/`C;`y!vC@fgRU=3$t q| *ɿɾ 3j ~ 5`Q*飣+MӣݦK#n pqIDrhe젩yXb(icCI e-mlUk {`H]5m-fޢ2'O6jˋr^{z%GӴjq8P1O!u"ސt۶ӻ TоW حO"y%}o!k{4mA{ٟ܎dGG;xCu 0;FKj=d6t3";:zk\ Xָ+how{JgҳwfD8<}oH@ш#0xaꎺ#SG :h]JSA_} ͩCZrzOin)FyTrkRK$ ^ v"ZPZn&Z$y:#)JO:m+cZh@ I7&VL ;RDC u{@ h!!ÂL?mYc:NY5ym`b`zKv:QBfKl-lOdtXh?.Z[ V[^Yrܞ џOd5!T *a"K"2 Jᾇgrn.9%K^ _gR@oG<.7Xu-jݮR}zeq|(.7mn$?C=9pn(%GI5H8=ilh>X#1C͜܆ zy7H;^s@x.;cT3 )h;,'f6'D}-,TsҠ QNžu0w+/kN*nT)2pځDu&hC]6OYTD0e5; E ,qלEz7H"z%=8{)dr;lg[.JrQaOVX'v z%:"><25$k.G4S`DN8L9qDhj>p)Yɑ,9 ]F%o|6R{ƫLe7l.Ox.ؙ+NjI˾iisMs~8\.ԝ/P}} d|^z8_h.RLfW+X'Rfu$Y3l,Ǹ i 8=04XS:+Օȗ"+T+L->V[t sQW43R*У>.j=+WWwrjA:Tsih*&,dmXAsM\6b 4Bf6`*RR3-tɩ#\2pM37-HPRyu``W&9$FI.@FK͑8H-a|9Fylr)cΘ;wH&-%gvO\lfVifK2K4/ ##Mj?,TOC{{$zy s,:ު q`@ ,JK.fgd7\O=jA9#RsēfxFj_sv0`~ffJn>R-d,B'sŃ7AkHyU<]>pFI-f)sYKnD> qN3$\,H=ODtM6"|qő AkXhf rM;$/rZ[*3?ư fQ]VfpCՈ #K\4~U;0Tq"C9Fm>2#k+0p]1Bu!yپp٦ 23.$uYrh칚286$s;5[CEM\s?ʨR^5}pQ>xeXȸPvD\1wn05eO"pGb9Ŕ&# ߘ=737k4ppյX72isn4'J6p]D͟\(n\h\$G7K¸qh).e&/k#W]#G/9u% =hKKc=D+n&ܷ|&zzp A8sd!t{X~O78Ur߲Eɱ\M0A(Z% M$s;hrY [p^4(#%Mx䚷ɚ:pU~ S_RL" r_2dWrmcnɩEw?Wp}eWr@ZrYr759';!;RSI7ymBtMW/^ط_}e1w߉7yvyC%ת(h\ȟ_a=%oBUq&yxK+rrk/CD̑ʪAf{# ;9 LA!+OOOk9s^/̧ʾ^Oo%D8_[\{jTe[UF ׯܦ>L`@_ܑ\q5`LS,~=/qI(h D-enrпos83 &;ir/8+K0f`%=EP! #NSO}A0 1T5dQUmna%9;ï.?E#GpsLS ]rG4瓓!ϩ= VEGQ>D~Q=(\$wmlp)np]~k$ l9ffzCBYq1&鳒Sz2[d~USK߳h^;!4w缁557%n'Bk*'n*)18"!r+|sh츲iR̹˕G==߳jqw#i8.OP]T[Cw=|- 3`l5'4-Ȭ'iOJ|u/:5"Cl]ޮ9ة _9t31جcټH&^4q3RIS7wp-HSjK*jCCAP%SGf|LJ !9M%,. 3ԔTnXBNRA4: ,L~t#)LEqzDQ@Tg'}B0A +s=cOW|'Z؞Ŝ:V,"YWДxL |B_̡ի!@ܾWYCזh]¼=U1Ё JnC1y9*l1š.c}U?ެB\PODf`͝\)OVGj6\>-2q%1CՈ*CG:J]Æ zڡ(:6Ѐᆏ[K*jp4xknB>A?JWG""&]bBN*.Wّ"QN|JGK8Bj2Wn r@);niu$ 죆&HS=6IYFQyl*uAU`G`Ap>(vĺ6S\ť]4: t-ZYB9IYesb49k~(qon}. M/|>Ւ-ѯ= k͇GghnZAߣxut\me6x h#p1Τe>SE:qUB|l 3O9O5!(Iv@HTuQ܈OqyGd&+.c5y6$:8ם)>DQj<(ujP1%y,wPPW*"{]p|Z-RU⟬W)7SY*# tz 2ۓh01d\c WZ/Ϸ  *pgL.!KS:\&pa79UZ`zliCM.zan]P嚰[F\^OA1}_>6 fAfmRLiXvAqv!Ayo!mVKJ/dw 6RhC4D+E [j!wBY(V Ϫ]/= ޫ7|ҽ{O+}uPpP mVi{"ݺxAw/͐7:֐ ٺA{sÍ uc.uǨ{ťo W[J]]9>/F6,:/￟ k]>1wy]Ap:u"8M=taTAGEy% \AJ_ŠI)#7xcޮv$`ALP{p/k67i55@B LTitleX$$d %d &d 'd 1$7$8$H$N O P Q a$ 5CJ \vSv L Table Grid7:V01$7$8$H$4@b4 3Header  !4 @r4 3Footer  !.X@. WEmphasis6]6U@6 j Hyperlink >*B*ph;r;ru/9g %&'():NOPQRSVg{|}-./014EFGHWklm}/012>J\bt~ 456DXYZbvwxy|  !/CDEMabcdg,-.<PQRZnopqt  234BVWX`tuvw}TUVWZ    ) * + , - . / 0 4 x y z { | FGHIJNJKLMNRpqrstx,-./0123TUVWXYZ[!]^_`abcdklmnos=>?@AE*OUVx[o}00x0000000000H 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0L 0H 0H 0H 0H 0H 0H 0H 0L 0H 0H 0H 0H 0H 0H 0H 0H 0L 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0L 0H 0H 0H0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0H 0H 0L 0H 0L 0H 0H 000 0@0 @0 @0 @0 0 0 0 0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0@0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0 @0H @0H @0H @0L @0H @0H @0H @0L 0H 0L 0H 0H 0L 0H 0L 0H 0H 0L 0H 0H 0L 0H 00L 0H 0L 0H 0H 0L 0H 0H 0H 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L 0H 0H 0L @0H @0H @0L @0H @0H @0H@0H @0L @0H @0H @0H @0L @0H @0H @0H @0L @0H @0H @0H @0L @0H @0H @0H @0L @0H @0L @0H @0H @0L @0H @0H @0H @0L @0H @0H @0H @0L @0H @0H @0H @0L @0H @0H 0@0L @0H @0H @0H @0L @0H @0H @0H @0L @0H @0H @0L @0H @0H@0H @0L @0H @0H @0L @0H @0H @0L @0H @0H @0L @0H @0H @0L @0H @0H @0L (0(000x0x00x0x00x0x00x0x00x0x00x00x0 @0@0@0@00L 000000H000t _`9g%&':RS{|-.01FGkl01>J~ 45DXYbvwxy  /CDMabcd,-PQnopq  23VWtuvw}VWZ   ) * / 0 x y { | FGIJJKMNpqst,-TU]^klno=>@Az00Oy00z00z00Oy00Oy00z00z00TԼ'z00T`Oy00] Oy00t  z00t 0z00t 0z00t h:0 0T0vz0 0t z0 0Tz0 0t :00Tvz0 0t :00Tvz0 0t z00t z0 0t z00T,wz00Tkz00T z00Tkz00Tkz0 0T,lz0 0T,lz0"0Tdlz0"0Tdlz00T`xz00T`xz00T@z00 8z00T@@0 @0 z00T@z00T*z00T*z00T*z0#0Th+@0@ z0#0Th+z0%0T+@0 z0%0T+z0'0T @0 z0'0T z0)0T @0 z0)0T z0+0T0@0@ z0+0T0z0/0Tmz0/0Tmz00T@0@ @0@ z00Tz00Tz00T@0@ z00Tz0 0T@0@ z0 0Tz0"0T@0@ z0"0Tz0;0TLz0;0TLz00T@0@ @0@ z00Tz00Tz0%0Tz0%0Tz0 0Tz0 0Tz0"0Tz0"0Tz0G0Tz0G0Tz00T@0 @0 z00T@0 z00Tz00Tz00Tz0 0Tz0 0Tz0"0Tz0"0Tz0S0T쾠z0S0T@0zzz0S0Tz0W0TlL'@0zzz0W0T\z0Z0TL'@0zz z0o0\pz00*z0S0Tz00*9@0 z0`0ThM'@0zz z0`0ThM'@0zz z0d0TM'@0zz z0d0TM'@0zz z0h0THN'@0zz z0h0THN'@0zz z0l0T̀@0zz z0l0TN'@0zz z0p0T<@0zzz0p0T<@0zz z0t0T@0zzz0t0T@0zz z0x0T@0zzz0x0T@0zz z00TL@0zzz00TL@0zz z00TL@0zzz00TL@0zz z00ThM@0zzz00ThM@0zz z00TM@0zz z00TN@0zz z00THNz00THNz00THNz00THNz00THN@0zz z00TN@0zz z00T(O@0zzz00T(O@0zz z00TO@0zzz00TO@0zz z00T@0zzz00T@0zz z00T @0zzz00T @0zz 0zzEEEEEEEEEHE h f   xH"%ؿi"&),/369<?BEINU\gmo  h J H  "^f44P@Z b1vf ")#N#$$ %%%<BJRƾw|: !#$%'(*+-.0124578:;=>@ACDFGHJKLMOPQRSTVWXYZ[]bcdefhijkln :FLgsy %+Wci}-JZbr~  ,2DPVbnt /;AMY_$*<HNZfl *0BNT`lrXFFFFFFFFFFFG G G$G$FFFFFFFFFFFFFFFFFFFFFFF'.05@BH!l,b$JpbQ9e@p(  |  S LAI.`US`TUS`TV  # "` V  # "` B S  ?^ptG$tG t&Text1Text2Text3Text4Text5Text6Text7Text8Text9Text10Text11Check1Check3Check2Check4Text12Text13Text14Text15Text16Text17Text18Text19Text20Text21Text22Text23Text24Text25Text26Text27Text28Text29Text30Text31Text32Text33Text34;hX~Kc!Ec 0N=[Ca  !"#$%Mz,j.[s3WuB`+Om 1Usy45[_[g`e[33&''7899:Ogz,Wj}.11J[bs}}~ 3DWbu /BM`dd+<OZm 1BU`sww "$  Z[noxy}y[...................................)............  D0.1. 2.3.4.,E5.XE6.E7.0.H1.2.3.4.H5.6.7.40.l1.2.3.4.L5.6.7.80.p1.2.3.4.P5.6.7.<0.t1.2.3)4.T5.6.7.@0.x1.o2.Ho3)o4.o5.|6.7.00.h1.2.ػ3)4.H5.6.7.40.l1.2.ܽ3)4.L5.6.7.80.p1.2.3.4.P5.6.7.<0.t1.2.3.4.T5.6.7.@0.x1.2.3. 4.X5.6.7. AutoList1 AutoList2 AutoList3 AutoList4 AutoList5 AutoList6ML\{>s#w$dw' 23#&3~g4]5!69q=`?DNHo%IJ\bt~ 456DXYZbvwxy|  !/CDEMabcdg,-.<PQRZnopqt  234BVWX`tuvw}TUVWZ    ) * + , - . / 0 4 x y z { | FGHIJNJKLMNRpqrstx,-./0123TUVWXYZ[!]^_`abcdklmnos=>?@AE@Acrobat DistillerNe03:AdobePS Acrobat DistillerAdobePS Acrobat DistillerAcrobat DistillerLetterPRIV0''''(\KhC(EBDAeBookAcrobat DistillerLetterPRIV0''''(\KhC(EBDAeBookP8|GGGGGGGG!`@` ` ``````0@`x@UnknownGz Times New Roman5Symbol3& z Arial7&  VerdanaK,Bookman Old Style" h& & &; 3; 3! xxdMM3Q ?9STATE OF SOUTH CAROLINA Anna Albers Anna Albers$      Oh+'0 (4 P \ h tSTATE OF SOUTH CAROLINATAT Anna Albersnnannarenewal_application Anna Albers3naMicrosoft Word 10.0@F#@2@j@շ; ՜.+,D՜.+,H hp  SCDCAw3M: STATE OF SOUTH CAROLINA Title 8@ _PID_HLINKSAx6o http://www.state.sc.us/consumer  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz|}~Root Entry F"ٷData {g<1TableWordDocument(SummaryInformation(DocumentSummaryInformation8CompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q