Acknowledgement Form

CODE:  EEAEAA-E


M.S.A.D. #31

23 Cross Street

Howland, Maine  04448


ACKNOWLEDGMENT


I certify that I have received a copy of the M.S.A.D. #31 Administrative Rule on Driver Alcohol and Drug Use and Testing and other printed material explaining the effects of an alcohol and/or controlled substances problem.

     Dated:                                                                                                                                                                
                                                                                                                      (Driver's Signature)