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Client 10 # Certificate
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081032649 1000036979

.CERTlfICATE OE.. COMRLEl"ION.·.

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basparticipa~eqjn and succ~ssfuIlY.:.:.Gorf\pleted- aCtevel I curriculum pertaining to substance abuse and driving ~nd a
sub~t~b¢e JJSfl!::wa.tJat,on; ' JI}.!.s. tertificC!!~,~.s~ jssued with the understanding that the prescribed.. treatment, .ifr~quited , rriU$t
. : becompleted,aridthatfaflur~.by ttleclient, named hereon, to remain in and complete this ·treatment may resulfin .
cancell~tionof ~!s/be~c:i ~ ver'slipense by the Department of Highway Safety and Motor \(~hiC;It3$.{flpric1aStatute #~22.391J .
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Treatment was required at the evaluation.

This individual accepted the referral.

Ey~I~~tt~9 Q6mpletibn Date: 08/03/2007

:~~PletiO_~ ~f~i-;0i~~!%]~07 ').))) ..

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program ReprElsentative Signature . Date .
) ?rettn T$2 Ju~t{ce, M~r+•..
Executive Director

.This certifi.t:ateis vali~ only}f imprinted wi,h the.DU Iprogra rn walerm~rk .

.~i12 5 .PO. BOX 151351

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• TAMPA,.. fLO R1QA
.... . -... 33684· 813-875-62Q1 .",;":,,:'
, FAX 813-876-0648 ~www.duicounterattack .org
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