Mateen certification documents pg 56
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--- --- -----~-------, Florida Department Agriculture and Consumer Services Division Licensing CERTIFICATE FIREARMS PROFICIENCY FOR STATEWIDE FIREARM LICENSE Chapter 493, Florida Statutes Post Office Box 9100 +Tallahassee, 32315-9100 ADAM PUTNAM COMMISSIONER (850) 245-5691 www.mylicensesite.com completed Class Firearms Instructor. This form must completed its entirety. Type use black ink. Student Name Student SSN Agency License Range Score Exam Score Type other Specialized Training /00 THE STUDENT FAILED QUALIFY FOR ANY REASON, THE REASON MUST STATED SECTION Comments: certify that the above named student has satisfactorily completed the prescribed training set forlh the Department Agn cutture and Consumer Services Firearms Instructors Manual, that all information contained herein true and correct, and the best knowledge the above named student qualified carry firearm connection with his her duties. Instructor License Number Date -z.O* USE SOCIAL SECURITY Sections 493.6105, 493.6304, and 493.6406, Florida Statutes (F. S.), conjunction with section 119.071(5) (a) S., mandates that the Department Agriculture and Consumer Services, Division Licensing, obtain social security numbers from applicants. Applicant social security numbers are maintained and used the Division Licensing for identification purposes, prevent misidentification, and facilitate the approval process the Division. The Department Agriculture and Consumer Services, Division Licensing, will not disclose applicants social security number without consent the applicant anyone outside the Department Agriculture and Consumer Services, Division Licensing, required taw. [See Chapter 119, S., U.S.C. ss. 1681 seq., U.S.C. ss. 6801 seq., U.S.C. ss. 2721 seq., Pub. No. 107-56 (USA Patriot Act 2001), and Presidential Executive Order 13224.] ORIGINAL Copy: Mail DIVISION LICENSING BOX 9100 TALLAHASSEE, FL32315-9100 DACS-16005 Rev. 10!11 YELLOW Copy: Instructor copy. Must retained instructor for period two years from date training completed whether not the student passed the course. PINK Copy: Student copy. Given student upon completion course whether not the student passed the course.