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5691 Internet Address: http://mylicensesite.com ADAM H. PUTNAM COMMISSIONER SAMPLE NOTE: Place numbers and letters inside the blocks (see sample at right). S M I T H USE OF SOCIAL SECURITY NUMBERS The submission of the applicant s or licensee s social security number is voluntary and is requested pursuant to sections 119.071(5)(a)2, 493.6105(3)(d), 493.6304(2)(a) and 493.6406(2)(a) Florida Statutes, for identification purposes, to prevent misidentification, and to facilitate the approva.

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