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AI iP/ationa/ Safety Council
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f Defensive Driving Course- Certificate of completion
This certifies that the person named below has successfully completed theeNational
Safety Coundl Defensive Driving Course
/
DRIVER LICENSE NUMBER
COURSE COMPLETION DATE
FENLES I578NG JUNE 26, 1986 _
Name FENLEY, SUSAN I.
adman, 110 F STREET
Add-,
CIIY,sr,zlp PORT TOWNSEND, WA 98368
t
CONTROL NO.O 6 0 6 7 3 6
scun'
THIS DOCUMENT IS VOID IF IT IS REPRODUCED
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DDC REGISTRATION FORM
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river license
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3.
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? first Name
4.1
Mid.
Initial
5.
Exact Mailing Address
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Mailing Address con't.
(if more space is needed)
7.
City
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State Zip Code
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Your Home Phone
it. 3i? 3150 5i
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Your Work Phone
12. What is your age?
Place an "X" in the
correct box.
(O) C! 15 to 18
(1) .. 19 to 21
(2) f 22 to 25
(3) 26 to 34
(4) X 35 to 44
(5) 45 to 54
(6) 55 to 64
(7) 65 to 74
(8) 75 and over
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