Form FDACS-13359 "Request for Change of Information for Pesticide Applicator License" - Florida

What Is Form FDACS-13359?

This is a legal form that was released by the Florida Department of Agriculture and Consumer Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2011;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form FDACS-13359 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-13359 "Request for Change of Information for Pesticide Applicator License" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Agricultural Environmental Services
Please fax or mail to:
REQUEST FOR CHANGE OF INFORMATION
Pesticide Certification Section
3125 Conner Blvd., Bldg. 8
FOR PESTICIDE APPLICATOR LICENSE
Tallahassee, FL 32399-1650
ADAM H. PUTNAM
Section 487.046, F.S. and Rule 5E-9.026, F.A.C.
COMMISSIONER
Telephone: (850) 617-7870; FAX (850) 617-7895
Complete your name and license information plus other sections as needed to update your license file.
Legal Name:
Last
First
Middle
Suffix
License Type:
PUB License No:
PVT
COMM
Date of Birth:
Home E-Mail Address:
Business E-Mail Address:
Home Address:
Home Phone:
Home Phone 2:
Home Fax:
Mailing Address:
Cell Phone:
Pager/Beeper:
Business Phone:
Business Headquarters Phone:
Business Address:
Business Fax:
Other Phone/Fax:
Description:
(Include area code with all phone numbers)
I AM REQUESTING AN IMMEDIATE CHANGE TO THE INFORMATION LISTED ABOVE FOR MY
RESTRICTED USE PESTICIDE APPLICATOR LICENSE FILE.
Signature:
Date:
***** MUST BE SIGNED AND DATED *****
FDACS-13359 Rev. 09/11
Florida Department of Agriculture and Consumer Services
Division of Agricultural Environmental Services
Please fax or mail to:
REQUEST FOR CHANGE OF INFORMATION
Pesticide Certification Section
3125 Conner Blvd., Bldg. 8
FOR PESTICIDE APPLICATOR LICENSE
Tallahassee, FL 32399-1650
ADAM H. PUTNAM
Section 487.046, F.S. and Rule 5E-9.026, F.A.C.
COMMISSIONER
Telephone: (850) 617-7870; FAX (850) 617-7895
Complete your name and license information plus other sections as needed to update your license file.
Legal Name:
Last
First
Middle
Suffix
License Type:
PUB License No:
PVT
COMM
Date of Birth:
Home E-Mail Address:
Business E-Mail Address:
Home Address:
Home Phone:
Home Phone 2:
Home Fax:
Mailing Address:
Cell Phone:
Pager/Beeper:
Business Phone:
Business Headquarters Phone:
Business Address:
Business Fax:
Other Phone/Fax:
Description:
(Include area code with all phone numbers)
I AM REQUESTING AN IMMEDIATE CHANGE TO THE INFORMATION LISTED ABOVE FOR MY
RESTRICTED USE PESTICIDE APPLICATOR LICENSE FILE.
Signature:
Date:
***** MUST BE SIGNED AND DATED *****
FDACS-13359 Rev. 09/11