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0-610- / 6 i- e. 'orlvinued /D-k--,-;?o <br /> BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE <br /> Date: <br /> Expiration Date: <br /> In conformity with the provisions of Chapter 110, §5 of the Massachusetts General Laws, as amended, the <br /> undersigned hereby declare(s) that a business under the title of <br /> Business Name/DBA: STB Consulting Corporation Name: <br /> is conducted at Business Location: 284 Hooppole Road Certificate No. 2010-112 <br /> Business Type: Fundraising Consulting <br /> New [ ] Renewal [ ] Commercial [ ] Residential [ ] Email Address: sbelekewicz@yahoo.com <br /> Business Mailing Address: 284 Hooppole Road Mashpee, MA 02649 <br /> Business Telephone: 508-212-1843 Home [ ] Cell [ ] Phone: 508-477-0543 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Susan T. Belekewicz 284 Hooppole Road Mashpee, MA 02649 <br /> 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 <br /> *This license will not be issued unless this certification is signed by applicant or Federal Identification <br /> Number(Required) <br /> In case of emergency <br /> NAME: TELEPHONE 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 Chapter 62C,§49A Massachusetts General Laws <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE: ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing <br /> statement is true. <br /> A certificate 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 long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> igned Notary Public <br /> Commission Expires <br />