Detail by Officer/Registered Agent Name

Florida Limited Liability Company

CENTER FOR HUMAN FORMATION, PLLC

Filing Information
L09000118174 36-4663797 12/14/2009 12/12/2009 FL INACTIVE VOLUNTARY DISSOLUTION 04/26/2013 NONE
Principal Address
9495 SW 72ND STREET
SUITE B-295
MIAMI, FL 33173

Changed: 04/26/2012
Mailing Address
9495 SW 72ND STREET
SUITE B-295
MIAMI, FL 33173

Changed: 04/26/2012
Registered Agent Name & Address GOMEZ, CARLOS C
9495 SW 72ND STREET
SUITE B-295
MIAMI, FL 33173

Name Changed: 06/23/2011

Address Changed: 04/26/2012
Authorized Person(s) Detail Name & Address

Title PRES

GOMEZ, CARLOS C
PO BOX 140432
CORAL GABLES, FL 33114-0432

Title MGRM

DR CARLOS C GOMEZ AND ASSOCIATES PA
9495 SW 72ND ST - STE B295
MIAMI, FL 33173

Title MGR

GOMEZ, HOLLY
9495 SW 72ND ST - STE B295
MIAMI, FL 33173

Annual Reports
Report YearFiled Date
2011 04/29/2011
2012 04/26/2012