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BUSINESS CERTIFICATE# �r3'030 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 6_4 I3 . <br /> Expiration Date: 3/ <br /> In conformity 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: Perras Chiropractic Corporation Name: is conducted at <br /> Business Location: 400 Nathan Ellis Highway • <br /> Business Mailing Address: 400 Nathan Ellis Highway,Mashpee,MA 02649 <br /> Business Type: Chiropractic Business Telephone: 508477-6900 <br /> New I I Renewal I VI Certificate# 2009-015 Expiration Date 2/28/2013 <br /> Home Phone:!�j)g-tgf,*mail Address: cQr�wcr@Gowe iI K� <br /> by the following named persons: 1 <br /> Owner Name Owner Residence / // <br /> Michael R. Perras DC , f ZSeccG e.WiGh �^r� ,) 'wr cQ, /4fQ' 07_S6� <br /> �Icertify under the penalties of perjury that I, to the best of my knowledge and belief, have <br /> filed all state tax returns and paid all state taxes as <br /> jeg4red under law. <br /> 0��- �� -SW 3 <br /> ture 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 NUMBER: <br /> H(w <br /> Alarm Company: <br /> by thk <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 /> oaligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under <br /> t'h'uAiity of Massachusetts General Law,Chapter 62C,Section 49A. <br /> •... I:u i t <br /> The Conratouwea/rh of Massachusetts <br /> BARNSTABLE ss A. Q D /// DATE S 6 / <br /> Personally appeared before me the above-named /�I i �I.t.�t/t 4�v�-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 long as such business shall be conducted and shall lapse and be void unless so renewed. - <br /> Signed <br /> ,� ah �8M) Notary Public <br /> SEAL °� NOTARY PUBLIC <br /> Commonwealth of Mas ashuseps <br /> .A My Commission Eltpiris July 29.2016 Commission Expires: <br /> .10 <br /> "Your s. <br /> thCTiOtI�.' <br />