BENJAMIN RAY BROADFIELD IDPR Registered License verification

Business Entity

NOT RENEWED

License Type

IDPR Registered

Description

CERTIFIED EUTHANASIA TECHNICIAN

License Number

235000131

License Status

NOT RENEWED

Business

First Name

BENJAMIN

Middle

RAY

Last Name

BROADFIELD

Business Name

BENJAMIN RAY BROADFIELD

Original Issue Date

11/16/2007

Effective Date

11/16/2007

Expiration Date

04/30/2008

City

GALESBURG

State

Zip

61401

County

KNOX

Ever Disciplined

LastModifiedDate

06/04/2008

Case Number

2007006759

Action

Fine

Discipline Start Date

11/14/2007

Discipline Reason

failure to disclose criminal conviction.