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  • Department of State Division of Publications 312 Rosa L. Parks Ave., 8th Floor, SnodgrassrTN Tower Nashville, TN 37243 Phone: 615-741-2650 Email: [email protected]

    For Department of State Use Only

    Sequence Number: -------

    Rule ID(s): File Date:

    Effective Date: -------

    Filing Form for Stay of Effective Date on Rules, Withdrawal of Stay, and Withdrawal of Rules

    I Agency/Board/Commission: j Department of Children's Services__

    JDivision: , Licensure ______ ...::..._ __________________ _Contact Person: i Helen Rodgers Address: 315 Deaderick Street, 7th Floor, Nashville, Tennessee

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    Zip: 37243 ---

    Phone: 615-741-1404---- ---------

    Email: [email protected]

    Type of Action on Rule:

    __ Stay of Effective Date of Rules Rule Filing Date: -'-(m_m_A_'d_d_.,IY_,_Y.,,_.YY,_,_1 ______________ _

    Rule Original Effective Date: �

  • Department of State Use Only

    SS-7041 (March 2020)

    Date:

    Signature:

    Title of Officer: - - ~C .... DfD=--..,'-----'-'ro'-'-----'--'-' --"'s .... s ..... , ...::O::....:n....:......::er=.:.... _ _ ___ __ _

    Filed with the Department of State on:

    2

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    Tre Hargett Secretary of State

    RDA 1693

    1/27/2021

    IE21AMHRG Date Stamp


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