This is to certify that the legal religious name of inmate DC# ________ is
[INSERT LEGAL RELIGIOUS NAME]
__________________________________________
[Signature] Warden or Facility Head, Name of Facility
Fla. Admin. Code Ann. R. 33-603.101
Specific Authority 944.09 FS. Law Implemented 944.09 FS.
New 9-30-93, Formerly 33-6.0012, Amended 4-29-02, 5-20-03, 7-7-05, 12-12-06.