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Instructor : / /
RANDY SATER Date
I.D. Type
Student Name Student Signature DL State Other (type) Driver License #
(DS-1001) Page 1 of 2
7/31/2018 DRIVER SAFETY PROGRAM
Instructor : / /
RANDY SATER Date
I.D. Type
Student Name Student Signature DL State Other (type) Driver License #
(DS-1001) Page 2 of 2