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AUTHORIZATION, AGREEMENT AND CERTIFICATION OF TRAINING A. Agency, code agency subelement, B. Request Status (Mark (X) one) and submitting office number Resubmission Initial Correction Cancellation 1. Applicant`s name (Last-First-Middle Initial) Smith, Michael Section A - TRAINEE INFORMATION Please read instructions on page 6 before completeing this form 2. Social Security Number 3. Date of birth (Year and month) 4. Home Address (Number, street, city, State, ZIP code) 7. 1111 Connecticut Ave NW W Brookings , resubmission initial correction cancellation , number resubmission initial correction , initial correction cancellation , resubmission initial correction , code , type code , training , office number resubmission initial , telephone number , link to view codes , view codes , number resubmission in 27-Oct-2021 auto-generated