{DATE}
License Holder(s) Name
PROGRAM ADDRESS
CITY, MN ZIP CODE
License Number: NUMBER
Dear License Holder(s),
On {DATE}, {County/Private Agency} informed you that…{plain language summary of the conversations with the LH’s regarding serving clients}.
As of January 1, 2020, the Department of Human Services Commissioner may close a license if the commissioner determines that the licensed program has not been serving any client for a period of 12 months or longer. (Minnesota Statutes 245A.055) {Insert information about last known date of operation/date of licensure if program has never operated.} Therefore, this letter is to inform you that the license for your program will be closed on {DATE}.
You will receive a separate notice from the Department of Human Services when the license is closed, and the notice will explain how to request reconsideration of the closure if you believe the license was closed in error.
If you have any questions, please contact me at XXX-XXX-{XXXX}.
Sincerely,
{NAME}, Licensor
County/Private Agency
O: XXX-XXX- {XXXX}
F: XXX-XXX- {XXXX}
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