| Type | Issue Date | Qualifying Appointment |
|---|---|---|
| AGENCY LICENSE (2105) | 4/24/2008 | Appointment not required for this license type. |
| Street Address | City | State | Zip | County | Location Agent In Charge |
|---|---|---|---|---|---|
| 27 12TH STREET BSMT | LAKEWOOD | New Jersey | 08701 | EMANUEL GOLDSZMIDT (E161887) |