DR-410CE
N. xx/xx
APPLICATION FOR APPROVAL OF
CONTINUING EDUCATION CREDIT HOURS
Rule 12D-16.002
F.A.C.
Eff. xx/xx
Property Tax Oversight (PTO) Certification and Training
Complete and submit this form to the PTO Certification & Training team within two weeks of the course completion.
APPLICANT INFORMATION
Applicant’s name
Title
Business email address
Check one:
Office
Business phone number
Certified Florida Appraiser
Certified Florida Collector
CONFERENCE AND COURSE INFORMATION
Conference name
Location
Course length (hours)
Course name(s)
Date(s)
Please indicate attendance by checking.
(Add a separate sheet if necessary.)
PROGRAM SPONSOR OR INSTRUCTOR SIGNATURE
Program Sponsor or Instructor must sign to certify the applicant attended the course for the required number of hours.
Signature _____________________________________________________________
Total hours attended ________________
APPLICANT SIGNATURE
I have attended this program for the total number of hours indicated.
Signed _______________________________________________________________
Date _______________________________
Return this form to:
[email protected]
Certification & Training
Property Tax Oversight Program
Florida Department of Revenue
PO Box 3294
Tallahassee, FL 32315-3294
Or email to: