EFTA Document EFTA01356997

Page 14 2: Professional License Expiration Date: 01/01/5001 Status: IN THE REGISTRY ACTIVE State: Florida 3: Professional License ation Name: SSN: Address: County: Phone: License Information Profession or Board License Type License Number Issue Date Expiration Date Status 4: Professional License State: Florida Name: SSN: Address: County: Profession or Board: License Type: License Number: Issue Date: Expiration Date: Status: 5: Professional License State: Name SS