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Printable Form 211 Pembroke Pines Florida: What You Should Know

The following sections are mandatory to provide to an officer, medical examiner or other agent, or any other person, who asks you.  “I understand there may be a delay of twenty-four hours in getting the results of this drug test, or the results of the test may be delayed or not immediately available to me.  If such a delay should occur, I authorize the officer or any other agent or official, representative or employee of the City of Pembroke, as the case may be, to submit said results to said officer, medical examiner or agent.” “I fully understand there may be a delay in getting any results of this drug test in connection with my release.” “I understand that I may receive a verbal or written notice within twenty-four hours from my own police department that the results of the test I had conducted have been found positive. “ “I understand that all the foregoing shall occur without notice.  The City of Pembroke will assume no liability for any delays in the completion or presentation of any drug tests provided pursuant to this order, or of any failure to notify me of any such delay or failure to announce the results of any such test within twenty-four hours.” My name _______________ Age _____ I ______________________ Affiliation and Employment “I certify that I am an actual resident of the State of Miami, Florida and have lived in the City of Coral Gables, Florida on a full-time basis for the period of _________________.” I ___________________________ Current address “I certify that I am a permanent resident of the State of Florida.

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