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- "Termination of Registered Employee and/Or Certified Applicator" - Delaware
"Termination of Registered Employee and/Or Certified Applicator" - Delaware
Termination of Registered Employee and/Or Certified Applicator is a legal document that was released by the Delaware Department of Agriculture - a government authority operating within Delaware.
Form Details:
- Released on August 2, 2002;
- The latest edition currently provided by the Delaware Department of Agriculture;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Delaware Department of Agriculture.
!["Termination of Registered Employee and/Or Certified Applicator" - Delaware](https://data.templateroller.com/pdf_docs_html/1782/17829/1782926/page_1_thumb.png ""Termination of Registered Employee and/Or Certified Applicator" - Delaware")
1Delaware Department of Agriculture
Pesticide Compliance
2320 S. DuPont Hwy., Dover, DE 19901
Tel. (302) 698-4571
Fax (302) 697-4483
(800) 282-8685 – DE Only
TERMINATION OF REGISTERED EMPLOYEE AND/OR CERTIFIED APPLICATOR
Business Name and Address:
Name
Business License Number
Street
City
State
Zip
Telephone Number
Date of
Check if I.D. Card
Employee Name
Social Security No.
Certification No.
Termination
Returned
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Name of Authorized Individual:
Print Name
Signature
Date
Document No. 65-01-06/02/08/02
Delaware Department of Agriculture
Pesticide Compliance
2320 S. DuPont Hwy., Dover, DE 19901
Tel. (302) 698-4571
Fax (302) 697-4483
(800) 282-8685 – DE Only
TERMINATION OF REGISTERED EMPLOYEE AND/OR CERTIFIED APPLICATOR
Business Name and Address:
Name
Business License Number
Street
City
State
Zip
Telephone Number
Date of
Check if I.D. Card
Employee Name
Social Security No.
Certification No.
Termination
Returned
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Name of Authorized Individual:
Print Name
Signature
Date
Document No. 65-01-06/02/08/02
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DA Form 2062 "Hand Receipt/Annex Number"
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