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BUSINESS CERTIFICATE -6 Lf <br /> TOWN OF MASHPEE ,7 <br /> —r1 � �I P 1, t4 <br /> • Date: `1lA..YIP `1 l 2� � 3 i0 <br /> Expiration Date: 30 <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 a business under the title of <br /> Corporation Name: Business Name/DBA: po-m—ko, �O fOYJL� <br /> boccAeo-re, <br /> is conducted at Business Location: 14 Compass Drive <br /> Business Type: Child Care <br /> New VQ Renewal [ ] --Commercial [ ] Residential [ ] Email Address: <br /> Business Mailing Address: Business Location: 14 Compass Drive <br /> Business Telephone:508-596-4423 Home [ ] Cell L4 Phone <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Pamela Marie Robbins 14 Compass Drive <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 /> WWO_staaxes as requir d-ffnBeri <br /> iw�p Qn O t 550—7 Sb� <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: 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 subiect to license suspension or <br /> revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth ojMassachaserrs <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 /> Signed Notary Public <br /> • Commission Expires <br />