Unless otherwise indicated, submit all forms to clrfilings@tdi.texas.gov.
Continuing Care Retirement Communities
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| TDI Form Number | Description | File Format | Language |
|---|---|---|---|
| FIN321 |
Company Licensing Fee Transmittal Form Company Licensing and Registration Fee Transmittal Form to be submitted with filings. |
English | |
| FIN381 |
CCRC Filing Requirements for Certificate of Authority Instructions for an entity wishing to operate as a Continuing Care Retirement Community (CCRC) in Texas |
English | |
| FIN382 |
CCRC 1 - Application for Certificate of Authority to do Business in Texas Continuing Care Retirement Community (CCRC) application for Certificate of Authority to do business in Texas, CCRC From #1 |
English | |
| FIN383 |
CCRC 2 - Continuing care provider CCRC 2 - Application for Approval by the Commissioner for Release of Loan Reserve Fund Escrow Account Amounts |
English | |
| FIN384 |
CCRC 3 - Officers and Directors Page Continuing Care Retirement Community (CCRC) listing of all associated officers and directors, CCRC Form #3 |
English | |
| FIN385 |
CCRC 4 - Biographical Data Form for a For-Profit CCRC Continuing Care Retirement Community (CCRC) biographical data form to be completed by any person serving as a board member for a for-profit CCRC, CCRC Form #4 |
English | |
| FIN386 |
CCRC 4A - CCRC Biographical Affidavit for a Not-For-Profit CCRC Continuing Care Retirement Community (CCRC) biographical data form to be completed by any person serving as a board member for a Not-for-Profit CCRC, CCRC Form #4a |
English | |
| FIN387 |
CCRC 5 - Acknowledgement of Delivery of Disclosure Statement Continuing Care Retirement Community (CCRC) resident's acknowledgement of delivery of Disclosure Statement, CCRC Form #5 |
English | |
| FIN388 |
CCRC 6 - Format for Disclosure Statement Continuing Care Retirement Community (CCRC) detailed instructions and format for submitting Disclosure Statement, CCRC Form #6 |
WORD | English |
| FIN389 |
CCRC Form #6A - CCRC Instructions for Preparation of Disclosure Statement Continuing Care Retirement Community (CCRC) instructions for preparing Disclosure Statement filing, CCRC Form #6a |
English | |
| FIN390 |
CCRC 7 - Change of Control Statement |
English | |
| FIN391 |
CCRC 8 - Certification of Changes to Disclosure Statement Continuing Care Retirement Community (CCRC) certification of changes made to the Disclosure Statement, CCRC Form #8 |
English | |
| FIN392 |
CCRC 9 - Notice of Request to Release Entrance Fee Escrow Funds Continuing Care Retirement Community (CCRC) written notice of request to release entrance fee escrow funds, CCRC Form #9 |
English | |
| FIN393 |
CCRC 10 - Notice of Request to Release Funds from the Reserve Fund Escrow Account Continuing Care Retirement Community (CCRC) written notice of request to release funds from the reserve funds escrow account, CCRC Form #10 |
English | |
| FIN394 |
CCRC 11 - Notice by Provider of Repayment of Previously Released Funds to Escrow Account |
English | |
| FIN395 |
CCRC 12 - Affidavit of Repayment of Previously Released Funds to the Reserve Fund Escrow Account |
English | |
| FIN396 |
CCRC 13 - Notice of Lien |
English | |
| FIN397 |
CCRC 14 - Calculations Concerning Conditions |
English | |
| FIN398 |
CCRC Name Change Checklist Continuing Care Retirement Community (CCRC) charter amendment checklist to effect a name change |
English | |
| FIN403 |
CCRC Release Escrow Checklist |
English | |
| FIN590 |
Financial Analysis Fee Transmittal Form for MEWAs and CCRCs |
English | |
| FIN604 |
CCRC 1a - Application for authority to offer continuing care in residence services |
English | |
| FIN605 |
CCRC 6B - Format for Disclosure Statement for Continuing Care in Residence |
WORD | English |
| FIN607 |
CCRC 14a - Provider request for release of continuing care residence entrance fee escrow funds |
English |
For more information, contact: CompanyLicense@tdi.texas.gov