Form FDACS-13604 "Limited Certification for Commercial Landscape Maintenance Personnel" - Florida

Form FDACS-13604 or the "Limited Certification For Commercial Landscape Maintenance Personnel" is a form issued by the Florida Department of Agriculture and Consumer Services.

The form was last revised in October 1, 2015 and is available for digital filing. Download an up-to-date Form FDACS-13604 in PDF-format down below or look it up on the Florida Department of Agriculture and Consumer Services Forms website.

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Download Form FDACS-13604 "Limited Certification for Commercial Landscape Maintenance Personnel" - Florida

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Florida Department of Agriculture and Consumer Services
Remit Fee Online at:
Division of Agricultural Environmental Services
www.FreshFromFlorida.com
- or -
LIMITED CERTIFICATION FOR COMMERCIAL
Check or Money Order Payable to
LANDSCAPE MAINTENANCE PERSONNEL
FDACS:
FDACS
ADAM H. PUTNAM
Revenue Processing Section
Section 482.156, F.S. and Rule 5E-14.117, F.A.C.
COMMISSIONER
P.O. Box 6710
Telephone: (850) 617-7997
Tallahassee, FL 32314-6710
IMPORTANT - DIRECTIONS:
(1)
Applicant must be 18 years of age or older to apply.
DO NOT SEND CASH.
(3)
Enclose a check or money order payable to FDACS in the amount of $150.00.
PLEASE REMIT SEPARATE CHECKS FOR EACH APPLICATION.
I hereby make application for the Limited Certification for Commercial Landscape Maintenance Personnel examination. (Proof of
insurance is required prior to issuance of the credential.)
Limited Certification for Commercial
Landscape Maintenance Personnel - 001365
$
150.00
TOTAL FEES ENCLOSED
$
All questions MUST be answered. PLEASE PRINT.
1.
Name of Applicant
(Last)
(First)
(Middle)
Mailing Address
(Street or Post Office Box)
(City)
(County)
(State)
(Zip Code)
Telephone Number
(
)
Email Address
(Area Code)
FL Driver’s License No. (or State ID)
2.
Name of Employer
(if applicable)
Street Address
(Street)
(City)
(County)
(State)
(Zip Code)
Employer Phone No. (
)
(Area Code)
3.
Have you previously been examined and failed in the category now applied for?
YES
NO
If yes, give month and year FIRST examined in category:
(Month)
(Year)
Date of Birth:
(Month)
(Day)
(Year)
Org. Code: 42 13 08 02 060
(Applicant’s Signature)
EO B7
Object Code: 001365
$ 150.00
County to be examined in:
FDACS-13604 Rev. 10/15
Florida Department of Agriculture and Consumer Services
Remit Fee Online at:
Division of Agricultural Environmental Services
www.FreshFromFlorida.com
- or -
LIMITED CERTIFICATION FOR COMMERCIAL
Check or Money Order Payable to
LANDSCAPE MAINTENANCE PERSONNEL
FDACS:
FDACS
ADAM H. PUTNAM
Revenue Processing Section
Section 482.156, F.S. and Rule 5E-14.117, F.A.C.
COMMISSIONER
P.O. Box 6710
Telephone: (850) 617-7997
Tallahassee, FL 32314-6710
IMPORTANT - DIRECTIONS:
(1)
Applicant must be 18 years of age or older to apply.
DO NOT SEND CASH.
(3)
Enclose a check or money order payable to FDACS in the amount of $150.00.
PLEASE REMIT SEPARATE CHECKS FOR EACH APPLICATION.
I hereby make application for the Limited Certification for Commercial Landscape Maintenance Personnel examination. (Proof of
insurance is required prior to issuance of the credential.)
Limited Certification for Commercial
Landscape Maintenance Personnel - 001365
$
150.00
TOTAL FEES ENCLOSED
$
All questions MUST be answered. PLEASE PRINT.
1.
Name of Applicant
(Last)
(First)
(Middle)
Mailing Address
(Street or Post Office Box)
(City)
(County)
(State)
(Zip Code)
Telephone Number
(
)
Email Address
(Area Code)
FL Driver’s License No. (or State ID)
2.
Name of Employer
(if applicable)
Street Address
(Street)
(City)
(County)
(State)
(Zip Code)
Employer Phone No. (
)
(Area Code)
3.
Have you previously been examined and failed in the category now applied for?
YES
NO
If yes, give month and year FIRST examined in category:
(Month)
(Year)
Date of Birth:
(Month)
(Day)
(Year)
Org. Code: 42 13 08 02 060
(Applicant’s Signature)
EO B7
Object Code: 001365
$ 150.00
County to be examined in:
FDACS-13604 Rev. 10/15
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