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BUSINESS CERTIFICATE Q17 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> P � I <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, <br /> the undersigned hereby declare(s)that a business under the title of <br /> Business Name/DBA: Counseling for Today's Issues Corporation Name: <br /> is conducted at Business Location: 39 Nobska Road <br /> Commercial Residential <br /> Business Mailing Address: 39 Nobska Road <br /> Business Type: Counseling Telephone No. 508-873-2132 <br /> New I I Renewal I I Home Phone: Email Address: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Sandra Farrell <br /> I certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> • all state taxes as required under law. <br /> 'Signature of authorized agent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> "This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE <br /> NUMBER: <br /> Alarm Company: <br /> **Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax <br /> filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or <br /> revocation. This request is made under the authority of Massachusetts General Law.Chapter 62C. Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLEss C' DATE <br /> Personally appeared before me the above-named -X'Ir-'�A'ra rGrr 1 and made oath that the foregoing <br /> statement is true. <br /> A cenilicate issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be <br /> renewed each four years thereafter so l�such business shall be conducted and shall lapse and be void unless so renewed. <br /> ll>SignedNotary Public <br /> 9-a a - �Qi7 <br /> Notary Public Commission Expires <br /> it <br /> Margaret C. Santos <br /> Seal CommomyeafthofMassaehusem <br /> SKY Commission Expires on Sept 22 2(111 <br />