PA-404 D-1411 - Texas Department of Agriculture - texasagriculture-2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section A, where you will enter your Applicant Information. Fill in your Driver’s License Number or State I.D. Card Number, along with the issuing state. Provide your first name, middle initial, last name, suffix, address, city, state, zip code, and phone number.
3. Proceed to Section B for Training Verification. This section must be completed by your course provider. Ensure they fill in their name, signature, affiliation, training date (mm/dd/yy), PA test score, test administrator's signature and name (print), and test date (mm/dd/yy).
4. Review all entered information for accuracy before saving or exporting the completed form.

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