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Judicial Watch • Mateen certification documents pg 56

Mateen certification documents pg 56

Mateen certification documents pg 56

Page 1: Mateen certification documents pg 56

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Number of Pages:1

Date Created:June 22, 2016

Date Uploaded to the Library:June 22, 2016

Tags:licensing, Score, Instructor, Statutes, agriculture, license, completed, Firearms, Chapter, reason, certification, social, Mateen, Consumer, Division, Student, Services, documents, security, 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
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.