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Get FL FDACS-13609 2014-2024

of Licensing and Enforcement Revenue Processing Section 407 S. Calhoun Street, Room 121 Tallahassee, FL 32399-0800 APPLICATION FOR PRIOR NOTIFICATION OF PESTICIDE APPLICATIONS Rule 5E-14.1055, F. A. C. Telephone (850) 617-7997 ADAM H. PUTNAM COMMISSIONER PART A – Pesticide Sensitive Individual Based on the information provided on the completed form below, including $50 initial registration fee - 001368 made payable to DACS, I request that my name be placed on the Florida Registry of Person.

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