BOARD OCCUPATION CERTIFICATE # INDIVIDUAL NAME BUSINESS NAME FIRST LINE ADDRESS SECOND LINE ADDRESS P O BOX # CITY STATE FIVE DIGIT ZIP CODE ZIP CODE EXTENSION PROVINCE COUNTRY POSTAL CODE EXPIRATION DATE CERTIFICATION DATE LICENSE RANK LICENSE SPECIALTY EMAILADDRESS 12 62 000379 JENNIFER C TUCKER 608 MAGNOLIA FARMS DR PETERSBURG VA 23803 0000 04/30/2028 04/22/2026 EI xquiziteminkzbeauty@gmail.com