Certificate of Occupancy Authorization FormTo the Director, Department of Consumer and Regulatory Affairs:This is to certify that I, am the true Owner of the Business described below:I FURTHER CERTIFY THAT THE PERSON(S) NAMEDBELOW IS/ARE AUTHORIZED TO ACT ON MY BEHALF INEXECUTING AND PROCESSING AN APPLICATION FORDISTRICT OF COLUMBIA CERTIFICATE OF OCCUPANCYRELATING TO THE AFOREMENTIONED BUSINESSESTABLISHMENT. American LegalNet, Inc. www.FormsWorkFlow.com