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Judicial Watch • Mateen certification documents pg 61

Mateen certification documents pg 61

Mateen certification documents pg 61

Page 1: Mateen certification documents pg 61

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Number of Pages:1

Date Created:June 22, 2016

Date Uploaded to the Library:June 22, 2016

Tags:Range, firearm, Score, Instructor, instructors, named, agriculture, completed, Manual, Firearms, reason, certification, Mateen, Consumer, Student, Services, documents, Florida, department


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Florida Department Agriculture and Consumer Services
Division Licensing
CERTIFICATE FIREARMS PROFICIENCY FOR STATEWIDE FIREARM LICENSE
Chapter 493, Florida Statutes
Rule 1.134. Florida Administrative Code
Post Ofllce Bo~ 5767 Tallahassee, 32314 5767 (850) 245-5691
www.mylicensesite.com
ADAM PUTNAM
COMMISSIONER completed Class Firearms Instructor. This form must completed its entirety. Type use black ink.
See Publication FOACS-P-01850, Firearms Instructors Training Manual Rev. 01114, for detailed instructions.
Student
Name fY1
Student
Date Birth (mm/dd/yyyy)
f2..
Type Training {select ONE)
Initial {28 hours)
1/6 /(!6
Annual Requalification hours)
Class license number: (;- 0:/t
Name Range
Written Exam Score
Range Score
2.2..3
Type (Revolver, Pistol, Shotgun)
s~w
Firearm Caliber
F=D~~=e~T~~ai~~~n;~c=o:Sf:::pl~~~;=.=!~)(~St=ud~e~-t
_;~:~~~?:re=~=W==~~~~========!:=D~K at~e~s/1;:i~n:!~ d7~f:/~_l:;,~~
__________________________________ THE STUDENT FAILED QUALIFY FOR ANY REASON, THE REASON MUST STATED THE COMMENT,S SEcl!foN J!i;:~OW.
c____________c____
=:i
ITT
;.. ~:r
~====== Comments
c__c~c__c~~~t.cFCccc.
f--------------~fl-ORlGJl1-Ab
-.~;; ;;: iiif2
Jr., CJ1 2._.._,.
-,r-I-------------------------------------------------------------------------~~;.~-~ F---S< --7~~-~hr----1 !.....:.tl
,.1~--
3!-iC
INSTRUCTORS CERTIFICATION
Select ONE: certify, for the reasons stated above, the above named student has not satisfactorily completed the prescribed training set forth the Department Agriculture and Consumer Services Firearms Instructors Training Manual; that all information
contained herein true and correct; and the best knowledge, the above named student not qualified carry
firearm connection with his her duties.
52J certifyand Consumer Services Firearms InstructorscompletedManual; that training set forth the Department
the above named student has satisfactorily
the prescribed
Agriculture
Training
information contained herein true and
all
correct; and the best knowledge, the above named student qualified carry firearm connection with his her
duties.
Instructor Name (type pjnt)
~~~-~~~~
lnstructo;..~re
-:i:::::
Instructor License Number
3~~--5----+~~k--~~~~~oq~;L__~~~~~~-----4
Date Signed
Phone Number
-//~~~~~~~~~~~-~/~?~-~~~ y~~(~7~7~~~3~2~J~-~8~6~~
ORIGINAL WHITE Copy: Mail!
DIVISION LICENSING BOX 5767
TALLAHASSEE, 32314 5767
FDACS 16005 Rev. 01/14
YELLOW Copy: Instructor copy.
Must retained instructor for two years
from date training completed, regardless
whether the student passed the course.
PINK Copy: Student copy.
Given student upon completion
course, regardless whether the student
passed the course.