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 13 00 010544 MI YOUNG LEE 13980 LIGHTBURN LN CENTREVILLE VA 20121 0000 07/24/2025 04/25/2025 BTP heyhyesu214@gmail.com