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ry, BUSINESS CERTIFICATE,2--()/,-) -163 1� <br /> TOWN OF MASHPEE <br /> Date: 5 Ilo l3 <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as <br /> amended, the undersigned hereby declare(s)that abusiness under the title of <br /> Corporation Name: l IK K/�1 QS5 C0J 11usiiness Name DBA (Salon 502 <br /> is conducted at Business Location: 5�2 I f IQI n s f �_f- 130 <br /> ✓0 M03hpet-, Mh 02040/. <br /> Business Type: Salm <br /> New Renewal [ ] Commerci [ ] Residential [ ] Email Address:i1 ifrrAX0 qffigi 1,00M <br /> P5pZ Main 5i - Vi- 130 fttsfir� !ma OZId-0 <br /> 1. <br /> Business Mailing Address: <br /> '[ Z-bBusiness Telephone: w)gi f-"I f 1 I Home Cell [ ] Phone:(]]4) 236 " 7412-- <br /> by <br /> y the following named persons: <br /> Owner Name Owner Residence <br /> Mn/ml: h Nijjcn HplivI r <br /> SarAvi'( , m 62*3 <br /> 1 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 /> "This license will not be issued unless this certification is signed by applicant or Federal Identification Number <br /> In case of emergency <br /> NAME: /t y� TELEPHONE NUMBER: <br /> Alarm Company: Cap��n� I IIQYm <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 �'IIDI2 <br /> BARNSTABLE, ss J� DATE <br /> Personally appeared before me the above-named t4 ��y�+ 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 yiars from the date of issue and shall be <br /> renewed each four, ears thereafter so long as such business shall be conducted and shall lapse an a void unless so re . <br /> Signed J\ \\I Notary o <br /> . Kw"Pia& <br /> Comm' a2W OF <br /> ' 11y fCIIlltbd,0.t�. <br /> OdCe1r <br />