Form FDACS-16027 "Letter of Intent to Sponsor for Recovery Agent Intern" - Florida

What Is Form FDACS-16027?

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 January 1, 2014;
  • 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;
  • Fill out the form in our online filing application.

Download a printable version of Form FDACS-16027 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-16027 "Letter of Intent to Sponsor for Recovery Agent Intern" - Florida

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Florida Department of Agriculture and Consumer Services
Division of Licensing
LETTER OF INTENT TO SPONSOR RECOVERY AGENT INTERN
Chapter 493, Florida Statutes
ADAM H. PUTNAM
Post Office Box 5767sTallahassee, FL 32314-5767s(850) 245-5691
COMMISSIONER
www.mylicensesite.com
INSTRUCTIONS: This form must be completed by the primary sponsor of a Class “EE” Recovery Agent Intern. The
designation of an alternate sponsor is optional. The sponsor or alternate sponsor must be a Class “E” or “MR” licensee.
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I agree to sponsor the intern named below. During this period of internship, the activities performed by this individual will be
under my direction and control, and I will provide a semi-annual progress report on this individual’s conduct and performance
on Form FDACS-16033 pursuant to Section 493.6116(5), Florida Statutes. In the event that I am unable to provide the
required direction and control to the intern, I hereby designate the alternate sponsor named above, whose signature appears
below and thus confirms the acceptance by that person of such designation. At such time that I no longer sponsor this
individual, I will notify the Florida Department of Agriculture and Consumer Services in writing within 15 calendar days
of the termination of such sponsorship, providing details about the performance of the intern, using Form FDACS-16017,
Termination/Completion of Sponsorship for Recovery Agent Intern.
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STATE OF FLORIDA
COUNTY OF
The foregoing application was sworn to (or affirmed) and subscribed before me this
day of
, 20
by:
pRiNt N
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S
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RimaRy
poNSoR
NotaRy SigNatuRe
,
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p
p
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I
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ype of
denTIfIcaTIon
roduced
I agree to fulfill the responsibilities of sponsor in the event that the primary sponsor named above is unable to perform those duties.
STATE OF FLORIDA
COUNTY OF
The foregoing application was sworn to (or affirmed) and subscribed before me this
day of
, 20
by:
pRiNt N
a
S
ame of
lteRNate
poNSoR
NotaRy SigNatuRe
,
,
pRiNt
type
oR Stamp Name of NotaRy
p
p
eRSoNally kNowN
Roduced ideNtificatioN
T
I
p
ype of
denTIfIcaTIon
roduced
FDACS-16027 Rev. 01/14
Page 1 of 1
Florida Department of Agriculture and Consumer Services
Division of Licensing
LETTER OF INTENT TO SPONSOR RECOVERY AGENT INTERN
Chapter 493, Florida Statutes
ADAM H. PUTNAM
Post Office Box 5767sTallahassee, FL 32314-5767s(850) 245-5691
COMMISSIONER
www.mylicensesite.com
INSTRUCTIONS: This form must be completed by the primary sponsor of a Class “EE” Recovery Agent Intern. The
designation of an alternate sponsor is optional. The sponsor or alternate sponsor must be a Class “E” or “MR” licensee.
N
R
a
/e
ame of
ecoveRy
geNcy
mployeR
a
B
S
a
, c
, S
, Z
c
geNcy oR
RaNch
tReet
ddReSS
ity
tate
ip
ode
a
p
N
a
l
N
l
e
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geNcy
hoNe
umBeR
geNcy
iceNSe
umBeR
iceNSe
xpiRatioN
ate
N
p
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l
N
l
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d
ame of
RimaRy
poNSoR
iceNSe
umBeR
iceNSe
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N
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(
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l
N
l
e
d
ame of
lteRNate
poNSoR
optioNal
iceNSe
umBeR
iceNSe
xpiRatioN
ate
I agree to sponsor the intern named below. During this period of internship, the activities performed by this individual will be
under my direction and control, and I will provide a semi-annual progress report on this individual’s conduct and performance
on Form FDACS-16033 pursuant to Section 493.6116(5), Florida Statutes. In the event that I am unable to provide the
required direction and control to the intern, I hereby designate the alternate sponsor named above, whose signature appears
below and thus confirms the acceptance by that person of such designation. At such time that I no longer sponsor this
individual, I will notify the Florida Department of Agriculture and Consumer Services in writing within 15 calendar days
of the termination of such sponsorship, providing details about the performance of the intern, using Form FDACS-16017,
Termination/Completion of Sponsorship for Recovery Agent Intern.
N
c
“ee” a
/l
“ee” l
N
S
p
S
ame of
laSS
pplicaNt
iceNSee
iceNSe
umBeR
igNatuRe of
RimaRy
poNSoR
STATE OF FLORIDA
COUNTY OF
The foregoing application was sworn to (or affirmed) and subscribed before me this
day of
, 20
by:
pRiNt N
p
S
ame of
RimaRy
poNSoR
NotaRy SigNatuRe
,
,
pRiNt
type
oR Stamp Name of NotaRy
p
p
eRSoNally kNowN
Roduced ideNtificatioN
T
I
p
ype of
denTIfIcaTIon
roduced
I agree to fulfill the responsibilities of sponsor in the event that the primary sponsor named above is unable to perform those duties.
STATE OF FLORIDA
COUNTY OF
The foregoing application was sworn to (or affirmed) and subscribed before me this
day of
, 20
by:
pRiNt N
a
S
ame of
lteRNate
poNSoR
NotaRy SigNatuRe
,
,
pRiNt
type
oR Stamp Name of NotaRy
p
p
eRSoNally kNowN
Roduced ideNtificatioN
T
I
p
ype of
denTIfIcaTIon
roduced
FDACS-16027 Rev. 01/14
Page 1 of 1