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The document is a State Central Registry Disclosure Form issued by the Louisiana Department of Children and Family Services, which must be completed by individuals associated with licensed child care facilities. It requires personal information and declarations regarding any history of child abuse or neglect. Falsifying information on this form is a misdemeanor offense. The form must be maintained according to licensing standards.

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Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (124 Votes)
2011	4.3 Satisfied (124 Votes)

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