State of Maryland Department of Labor, Licensing and Regulation
Maryland Board of Examiners of Landscape Architects
500 N. Calvert St., Room 308
Baltimore, Maryland 21202
(410) 230-6322 (Baltimore area),    (888) 218-5925 (Toll Free)

Landscape Architects - Form 2A - Report of Professional Experience Continuation Sheet

ENDORSER
NUMBER
SHEET
NUMBER
  OF 
Name: 
Last First Middle
Social Security Number: 
Signature:       Date of Birth: 
/ /
  TIME
YRS/MOS
Total this sheet
Total all sheets
SECTION IV: ENDORSER'S AFFIDAVIT: (COMPLETE ONE SIDE ONLY).
I have read the applicant's Report of Professional Experience. I hereby certify that I am knowledgeable about, and qualified to attest to, the applicant's work and Landscape Architecture ability and that, except as otherwise noted on this form, or in attached correspondence, the work experience described by the applicant and the time claimed therefore are generally true and accurate.

ENDORSER'S SIGNATURE
SEAL
DATE
 I cannot so certify. Letter of explanation attached.