LEE W BROUSSEAU Athletics Professional License verification

Business Entity

NOT RENEWED

License Type

Athletics Professional

Description

ATHLETICS - LICENSED MMA CONTESTANT

License Number

002165641-0016

License Status

NOT RENEWED

Business

First Name

LEE

Middle

Last Name

BROUSSEAU

Business Name

LEE W BROUSSEAU

Original Issue Date

10/15/2008

Effective Date

10/09/2009

Expiration Date

10/01/2011

City

WOOD RIVER

State

Zip

62095

County

MADISON

Ever Disciplined

LastModifiedDate

10/04/2011