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BUSINESS CERTIFICATE# c�(�/tJ-0 7 6 <br /> THE COMMONWEALTH OF MASSACHUSETTS P �� <br /> TOWN OF MASHPEE I Q <br /> DATE <br /> Expiration Date: 3 <br /> In�fformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the undersigned hereby <br /> declare(s)that a business under the title of <br /> Business Name/DBA: Kim's Daycare Corporation Name: is conducted at <br /> Business Location: 132 James Circle <br /> Business Mailing Address: 132 James Circle, Mashpee, MA 02649 <br /> Business Type: Day Care Business Telephone: 508-539-0754 <br /> New I I Renewal I VI Certificate# 2009-073 Expiration Date 7/31/2013 <br /> Home Phone: 508-539-0754 Email Address: kmifitness(a)comcast.net <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Kim Miller-Jones 132 James Circle, Mashpee, MA 02649 <br /> 1 certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state taxes as <br /> requiredu de law. < <br /> ,l"LC, � - ozi- 64(- 9d,7 ? <br /> tore of authorized agent V "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: y 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 filing or tax payment <br /> obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under <br /> the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The CommonweaUh of Massachusetts L13 <br /> BARNSTABLEss � DATE <br /> Personally appeared before me the above-named �, 1 N't U Prq S and made oath that the foregoing 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 renewed each four <br /> years thereafter so Ion as such business shell be cond cted and shall lapse and be void unless so renewed. <br /> Signed r <br /> Notary Public <br /> SEAL <br /> • Ptblle Expires: <br /> LIZ <br /> ouwoewt:ntnl w tusatpucErte <br /> My Comm'ssron Egtl3 <br /> Oaoeet 2s.eta <br />