07lc089e 2026

1. Click ‘Get Form’ to open the 07lc089e in the editor.
2. Begin by filling in the 'Facility requesting waiver' section. Enter the facility name, mailing address, city, license number, county, state, and zip code.
3. Next, provide your details in the 'Name of person requesting waiver' section. Include your first name, middle name, last name, and position (Owner or Director).
4. In the 'Person for whom waiver is requested' section, enter the individual's first name, middle name, last name, and their position or relationship to the facility.
5. Indicate whether this person lives in the facility by selecting 'Yes' or 'No'.
6. List all charges for which the waiver is requested along with their dates.
7. Answer if the person is currently on probation or parole and specify until what date if applicable.
8. Attach required documents such as a copy of the OSBI report and statements from community members as specified in the instructions.
9. Finally, ensure you sign and date the form at the bottom before submitting it to your licensing specialist.

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