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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700093
Report Date: 07/15/2026
Date Signed: 07/15/2026 01:06:49 PM

Document Has Been Signed on 07/15/2026 01:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MORALES FAMILY CHILD CAREFACILITY NUMBER:
157700093
ADMINISTRATOR/
DIRECTOR:		MARIA MORALESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(541) 403-0408
CITY:ARVINSTATE: CAZIP CODE:
93203
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 11DATE:
07/15/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:29 AM
MET WITH:Maria Moeales, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:56 PM
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On Wednesday, 07/15/2026, Licensing Program Analyst (LPA) Isabel Ortega conducted an unannounced Annual Random inspection at the Morales Family Child Care Home. Upon arrival, the LPA met with licensee, Maria Morales who guided LPA on a tour of the facility. All adults living in the home have been background cleared. Per Licensee, hours of operation are Monday through Friday 5:00 AM to 5:00 PM. Per licensee, no overnight care is provided at the moment. Upon arrival, LPA did observed eleven(11)children in care and two staff providing care and supervision.

This is a two-story home with 3 bedrooms and 2 ½ bathroom, the second floor is barricaded with a white child safety gate observed at the bottom of the stairs. Per licensee, care is primarily in the living room and backyard. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds, medication and hazardous items that can pose a danger to children.
LPA observed age-appropriate safe toys and napping equipment on the premises.
Per licensee main care is provided in the living room and backyard (divided with a child safety fence). LPA observed age-appropriate toys and furniture for the children. There are age-appropriate games and books on the premises. Per licensee, there is a designated area for ill/sick children in the living room. Children are provided with mats and playpens are provided for infants. LPA observed nap equipment to be properly stored. Children utilize the bathroom located by the hallway on the right-hand side from the main entrance of the home. . The bathroom was observed to be clean, sanitized, and in good repair.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MORALES FAMILY CHILD CARE
FACILITY NUMBER: 157700093
VISIT DATE: 07/15/2026
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Kitchen/Dining Room: The kitchen has a physical barrier. Sharp items are located in an upper cabinet. Per licensee, she currently participates in the food program. Meals offered: Breakfast, Lunch and PM Snack.

Fireplace: The fireplace is located in the living room and was observed to be properly barricaded

Backyard/Outdoor areas: The side yard is all fenced in and divided in two. The backyard is divided into two, one for personal space and one for the children to play . The outdoor play area was inspected and was observed to be free of hazards, lose or sharp parts and tools. LPA observed appropriate and safe toys in the play area. Per licensee and LPA’s observations, there are no pools or bodies of water in the premises.

Off-limits: Per licensee, the off-limit areas of the home include the 3 bedrooms and two bathroom and garage. Rooms and garage are made inaccessible a child safety gate.



Care and Supervision: Licensee is within the ratio, the Licensee was reminded that supervision is always required for children in care.

Fire/Health/Safety: There is a cell phone kept charged and on the Licensee at all times.


Smoke Detectors and Carbon Monoxide were observed to be in operable conditions.
The First Aid kit was observed to be complete with supplies including thermometer, tweezers, scissors, gauze, bandages, cleansing pad/solution, and a first aid manual. LPA observed a required fire extinguisher (2A10BC) reading in green and currently serviced within the year blue tag observed,with date 6/16/26.

Medications/ Hazardous Materials: Medications are stored in an upper cabinet. Cleaning compounds are stored in the garage cabinet in the kitchen, secured with a safety latch. Per Licensee there are no firearms or weapons in the home. LPA did not observe any weapons or firearms during inspection.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MORALES FAMILY CHILD CARE
FACILITY NUMBER: 157700093
VISIT DATE: 07/15/2026
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LPA went over Incidental Medical Services (IMS): When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. and kept on file. Currently no IMS plans are being providing.

Records: Children’s records were observed to be complete as well as the staff’s files. Licensee’s Pediatric CPR/First Aid is maintained current, it expires on March 7, 2028. Mandated Reporter Certificate is also maintained current, dated on 09/27/2025. Per Licensee, fire and disaster drills are conducted every 6 months; the last drill was documented and conducted on 06/12/2026 at 12:30 p.m. Per LPA’s observations, the Facility License, Emergency Disaster plan, Earthquake Preparedness and Parents Rights Poster were posted.

Documents Provided and or Discussed: Safe Sleep PIN 20-24-CCP and LIC9227 (Individual Sleeping Plan) and Sleep Logs. LPA discussed the safe sleep regulations with licensee Morales and discussed the Child Care Licensing Safe Sleep webpage at www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Provider Information Notices (PINs) & Child Care Advocates: Quarterly Updates on Rules, Regulations, Policies and PINs for one or more programs through our DSS website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe licensee was informed all forms pertaining to Child Care Licensing can be found at https://www.cdss.ca.gov/inforesources/forms-brochures/forms-alphabetic-list/i-l

Child Care Advocates Program: Provides information and resources about licensed childcare. www.childcareadvocatesprogram@cdss.ca.gov

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC809 (FAS) - (06/04)
Page: 4 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MORALES FAMILY CHILD CARE
FACILITY NUMBER: 157700093
VISIT DATE: 07/15/2026
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Megan’s Law - On this date, 07/15/2026, the California Attorney General - Megan’s Law website was searched for information on sex offenders required to register with local law enforcement under California's Megan's Law. No registered sex offenders were found at the facility addresses. Under state law, some registered sex offenders are not subject to public disclosure; therefore, they may not have been included in this search. However, the Department conducts a monthly cross reference of each address on record for all registered sex offenders against all CCLD facility addresses pursuant to information shared by California DOJ. MyChildCarePlan.org: Family Child Care Home Licensee was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

Criminal Record Clearance: Licensee [or facility representative] was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated. Inspection was conducted in Spanish, LPA is certified bilingual by the department.

Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assist in providing care. Licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and Licensing within 24 hours of incident by telephone and in writing within 7 days of incident to the department. Licensee was informed all suspected Child Abuse should be reported to the Child Abuse Hot-line at 1-800-540-4000. The above incident should be reported on the form LIC624B per the regulation. The form should be email to unusualincidentreport@dss.ca.gov

NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC809 (FAS) - (06/04)
Page: 5 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MORALES FAMILY CHILD CARE
FACILITY NUMBER: 157700093
VISIT DATE: 07/15/2026
NARRATIVE
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The following was also discussed with the licensee:

1. The following items are zero tolerance by Licensing: Refused Entry to a Facility or
Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations
101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations,
Accessible Bodies of Water, Accessible Firearms, Ammunition or Both
2. Pediatric First Aid and CPR: American Heart Association or American Red Cross or
Emergency Medical Services Authority (EMSA) approved in Pediatric First Aid and CPR
must be present. Certification must be renewed every two years.
3. Licensee was informed that the mandated reporter training must be completed every 2
years, and is available at www.mandatedreporterca.com
4. In the absence of the licensee a qualified adult must be present, supervising the
children; a qualified adult is an individual who has a valid and current Pediatric first aid/
CPR-adult-child- infant certification (EMSA approved), a valid criminal record clearance
associated to the facility license, immunization's (MMR, TDAP, TB and Influenza or
Influenza declination), AB 1207 Child Abuse Mandated Reporter Certificate.
5. A current roster of children enrolled must be available and maintained for a period of 3
years, even after children are no longer attending the facility.
6. Annual fees must be paid promptly and by the due date or a late fee shall be assessed
and/or the license shall be evaluated for termination.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC809 (FAS) - (06/04)
Page: 6 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MORALES FAMILY CHILD CARE
FACILITY NUMBER: 157700093
VISIT DATE: 07/15/2026
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7. The fire extinguisher Type 2A-10BC must be serviced annually or purchased yearly or
as often as necessary and smoke and carbon monoxide detectors shall be checked,
replaced every ten years and batteries replaced as needed.
8. Changes should be reported to the Department as soon as they occur such as
construction, remodeling, telephone number changes and/or if you move from your home.
9. Any unusual incidents or injuries must be reported to the Department within 24 hours
via telephone and within seven (7) days in writing (refer to LIC 624B).
10. Fire and safety drills must be performed every six (6) months and documented for
review by the Department.
11. Smoking is prohibited in the family childcare home.
12. Children and staff records must be maintained and updated as needed and be
available for review by the Department.
13. Immunization Requirement: H&S 1597.622: Commencing September 1, 2016, a
person shall not be employed or volunteer at a family day care home if he or she has not
been immunized against influenza, pertussis, and measles. The licensee and all adults
working with children have proof of immunization.
14. Inspection Authority: All adults living and working in the home shall be made of aware
of the Department’s right to inspection the home, which includes, but is not limited to the
right to enter the home when children are being cared for, interview children and adults
and review documentation
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC809 (FAS) - (06/04)
Page: 7 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MORALES FAMILY CHILD CARE
FACILITY NUMBER: 157700093
VISIT DATE: 07/15/2026
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15. The facility license number must be on all advertisements, publications, or
announcements with the intent to attract clients.
16. Isolation for children: When a child is ill, he/she shall be separated from other children
(reference 102417(e) Operation of a Family Childcare Home).
17. Liability Insurance was discussed; LPA informed licensee to review Title 22 Regulation
102417(m)(1) for additional information.
18. Dog(s) and/or pets are recommended to be isolated from children in care.
19. No baby bouncers, no infant walkers, no Johnny jumpers, no saucer chairs, and any
other item that falls into this category is not permitted in the facility.

To improve the quality and value of the new inspection process, a survey may be sent to
the email address provided. Please complete the survey and share your inspection
experience. If you have any questions regarding the process or CARE tools, please send
email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the
inspection and its tools and methods, please visit the Program website at
www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
Safe Sleep regulations (under 24 months) were discussed with Licensee and referred to
the CCL web site for additional information and PINS. Infants under 2 years of age shall
have the 15-minute checks logs completed during nap time. All infants under one year of
age shall have the LIC9227 sleep plan completed by parent until infant master’s
developmental stage of rolling over on their own.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC809 (FAS) - (06/04)
Page: 8 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MORALES FAMILY CHILD CARE
FACILITY NUMBER: 157700093
VISIT DATE: 07/15/2026
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Safe Sleep webpage at
https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresource
s/safe-sleep as an additional resource. LPA also informed licensees of the importance of
checking for recalled infant devices on the United States Consumer Product Safety
Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all
infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN
22-02CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the
Department. The following information regarding ADA was provided: US Department of
Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383
(TTY) and link to publication: Commonly Asked Questions about Childcare Centers and
the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

MyChildCarePlan.org-Family Childcare Homes Licensee was informed of the
MyChildCarePlan.org website; a consumer education website that helps families obtain
childcare by connecting them to childcare providers and Resource and Referral Agencies
(R&Rs) throughout California.

Megan’s Law - Family Childcare Homes During the exit interview, according to
licensee there are no Registered Sex Offenders living in the facility and LPA completed
the RSO profile in FAS.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC809 (FAS) - (06/04)
Page: 9 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: MORALES FAMILY CHILD CARE
FACILITY NUMBER: 157700093
VISIT DATE: 07/15/2026
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Childcare Advocates:

To sign up for our Quarterly Updates please email the Childcare Advocates at
chilcareadvocatesprogram@dss.ca.gov & (916) 654-154.
The licensee was informed of the responsibility to report suspected Child Abuse by calling
the Child Abuse Hot line at 1-800-540-4000.

The facility is complying with Title 22 regulations no citations were issued today.

An exit interview was conducted, a copy of this Report, a Notice of Site visit and Appeal
rights were provided and discussed.

All licensing reports are recommended to keep for 3 years, and the Notice of Site visit is
to be posted visible to parents for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Lady King
NAME OF LICENSING PROGRAM ANALYST: Isabel Ortega
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026
LIC809 (FAS) - (06/04)
Page: 10 of 10