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2016 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT FILED <br /> DOCUMENT#L14000036503 Apr 28, 2016 <br /> Entity Name: PROVIDENCE BESA, LLC Secretary of State <br /> CC6059055159 <br /> Current Principal Place of Business: <br /> 9603 ORANGE JASMINE WAY <br /> TAMPA, FL 33647 !D ,U\ <br /> (T'. <br /> Current Mailing Address: <br /> 9603 ORANGE JASMINE WAY 5 V �� <br /> TAMPA, FL 33647 US <br /> FEI Number: 46-5110923 Certificate of Status Desired: No <br /> Name and Address of Current Registered Agent: <br /> AHMED,BASIM M <br /> 9603 ORANGE JASMINE WAY <br /> TAMPA,FL 33647 US <br /> The above named entity su6mits this statement for the purpose of changing its registered o�ce or registered agent or both,in the State of Florida. <br /> SIGNATURE: <br /> Electronic Signature of Registered Agent Date <br /> Authorized Person(s) Detail : <br /> Title CEO Title VP <br /> Name AHMED,BASIM Name AHMED,ERUM <br /> Address 9603 ORANGE JASMINE WAY Address 10837 CORY LAKE DRIVE <br /> City-State-Zip: TAMPA FL 33647 City-State-Zip: TAMPA FL 33647 <br /> Title VP Title VP <br /> Name AHMED,SAMEER Name MIRZA,ANUM <br /> Address 20237 RAVENS END DRIVE Address 6990 FALLS REACH DRIVE,APT 106 <br />' City-State-Zip: TAMPA FL 33647 City-State-Zip: FALLS CHURCH VA 22043 <br /> c <br /> �.�� �7 � �G�� � <br /> � <br /> � <br /> , ��� 3�v 2f' �I <br /> � <br /> I here6y cer6ly that fhe!n(ormafion indicaled on thls report or supplemenfal report is frue and accurate and that my e/ectronic signatuia shal/have the same legal eNect as ilmade under <br /> oath;that l am a managing member or manager o/the limited lia6iliry company or the receiver or frustee empowered to execute this raport as required by Chapfer 605,Florida Statutes;and <br /> that myname appears a6ove,oron an attachmenf wdh all otherlike empowered. <br /> SIGNATURE:BASIM AHMED CEO 04/28/2016 <br />', Electronic Signature of Signing Authorized Person(s)Detail � Date <br />