JASON P MEDINA Athletics Professional License verification

Business Entity

NOT RENEWED

License Type

Athletics Professional

Description

ATHLETICS - LICENSED BOXER

License Number

002164568-0003

License Status

NOT RENEWED

Business

First Name

JASON

Middle

Last Name

MEDINA

Business Name

JASON P MEDINA

Original Issue Date

09/26/2005

Effective Date

09/26/2005

Expiration Date

10/01/2007

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Ever Disciplined

LastModifiedDate

11/08/2007