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Judicial Watch • Mateen certification documents pg 33

Mateen certification documents pg 33

Mateen certification documents pg 33

Page 1: Mateen certification documents pg 33

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Number of Pages:1

Date Created:June 22, 2016

Date Uploaded to the Library:June 22, 2016

Tags:instructors, license, completed, Tallahassee, certification, Mateen, Consumer, Student, AGENCY, Services, documents, Florida


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FLORIDA DEPARTMENT AGRICULTURE AND CONSUMER SERVICES
DIVISION LICENSING
Post Oftice Box 6687 Tallahassee, 32314-6687 (850) 245-5499
Internet Address: http://Hcgweh doacs S@t~.O
Chapter 493, Florida Statutes
CERTIFICATE FIREARMS PROFICIENCY FOR STATEWIDE FIREARM LICENSE
This form must completed its entirety. Type use black ink.
Student Name
Students S.S if.
M-4-/2.-
Agency License
Employing Agency
Other Specialized_Training
L--
Comments: certify thai lhe above nomed student satisfa
Manual, that all Information contained herein
completed the presa1bed ttainfng 1oM the Oepartnlent oiAgrio.dture and Consumer Services Firearms tnstructots Training
edge the above named student qualified carry llrearm c:onnectlan wilh ttl$ her duties.
Instructors Name (print type)
Instructors Signature
1.
Mail Original to: Florida Departmint ofAgriculture and Consumer Services Yellow Copy:
Division Ucensing
Pink Copy:
Post Office Box 6687
Tallahassee. 32314-6687
DACS-16005 12/05
Instructors License...
Date
2,/ I{)
inSt~~pe
Instructors copy. Must retained
ollwo years !rom
date training completed whether not the studen1 passed the course.
Studenls copy. Given student upon completion course whether net the
student passed the course.