TX HHS Form 3725. Licensure Change of Ownership Affidavit

The TX HHS Form 3725, Licensure Change of Ownership Affidavit, is a document used to notify changes in ownership or operational control of a facility licensed by the Texas Health and Human Services (HHS). This form helps solve the problem of updating licensing information when there is a change in ownership or management.

This affidavit requires providing key information about the facility, including its name, ID number, and transfer date. The outgoing owner must affirm that all operational functions have been transferred to the incoming owner, while the incoming owner must also affirm that the provided information is complete, true, and correct. Notarization of both signatures is necessary before submitting the form.

The completed and notarized form should be mailed to Texas Health and Human Services Commission or Regulatory Services at one of two addresses: P.O. Box 149030 Austin, TX 78714-9030 or 701 W. 51st Street Austin, TX 78751. This form is essential for maintaining accurate licensing information and ensuring compliance with regulatory requirements.