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)