Form Des-029 - Segment 1 And Segment 2 Completion Certificates Order Form
Download a blank fillable Form Des-029 - Segment 1 And Segment 2 Completion Certificates Order Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Des-029 - Segment 1 And Segment 2 Completion Certificates Order Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1SEGMENT 1 AND SEGMENT 2
DES-029 (03/2017) By Authority of 2006 PA 384
Michigan Department of State (517) 241-6850
COMPLETION CERTIFICATES
ORDER FORM
Instructions: This order form may only be used by certified driver education providers who have been
approved to offer teen driver education programs. Please fill in all of the requested information including
your driver education code and provider certificate number. Orders without the driver education code
and provider certificate number will not be processed.
All orders for completion certificates are shipped via UPS and delivered only to the provider’s business
office address (the address that appears on the school’s provider certificate). UPS requires a signature
when delivering certificates. If no one is available to accept delivery of the certificates, it is your
responsibility to pick up the certificates at your local UPS office.
Please fax all order forms to the Department of State’s Inventory Services Section at 517-316-1621.
Please limit orders to no more than a four-month supply.
Driver
Provider
Education
Certificate
Code
Number
Provider
Name
Complete
Address
Contact
Telephone
Person
Number
# of Packages
Form Name
Form No.
Unit of Issue
____________
Segment 1 Certificate of Completion
DES-001
Package of 100
____________
Segment 2 Certificate of Completion
DES-002
Package of 100
Orders for Segment 1 and Segment 2 completion certificates must be signed by the owner, driver education coordinator,
or authorized representative. The person who signs the order must be the same person whose name appears on the
provider certificate application as an owner, partner, officer, director, or designated representative/coordinator.
___________________________________________________________________________________________
Signature
Printed Name
Title
Date
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Rr 1 - Schedule 2 - Class 1 And Class 2 - Right-of-way, Terminal And Yard Lands And All Buildings, Structures And Other Improvements Thereon, Not Included Under Section 1, Class 1 And Class 4.
Financial
Form Mv-278.8 Ssc - Mv-278/pre-licensing Course Completion Certificate Order Form For Secondary Schools And Colleges
Legal
Form Mv-278.8 Cds - Mv-278/pre-licensing Course Completion Certificate Order Form For Commercial Pre-licensing Course Providers
Legal
Schedules M-1 And M-2 (form 1120-f) - Reconciliation Of Income (loss) And Analysis Of Unappropriated Retained Earnings Per Books - 2017
Financial
Schedules M-1 And M-2 (form 1120-f) - Reconciliation Of Income (loss) And Analysis Of Unappropriated Retained Earnings Per Books - 2015
Financial
Schedules M-1 And M-2 (form 1120-f) - Reconciliation Of Income (loss) And Analysis Of Unappropriated Retained Earnings Per Books - 2014
Financial
Schedules M-1 And M-2 (form 1120-f) - Reconciliation Of Income (loss) And Analysis Of Unappropriated Retained Earnings Per Books - 2012
Financial
Related Categories
Parent category: Legal