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BUSINESS CERTIFICATE 1y3 <br /> TOWN OF MASHPEE <br /> Date: GeCembe a I act U <br /> • Expiration Date: . hoc ombQv- s t ao 1 Y <br /> In conformity with the provisions of Chapter 110, §5 of the Massachusetts General Laws, as amended, the <br /> undersigned hereby declares)that a business under the title of <br /> Business Name/DBA: Dodie's Embroidery Corporation Name: <br /> is conducted at Business Location: 82 Horseshoe Bend Way Certificate No. 2010-142 <br /> Business Type: Embroidery <br /> New [ ] Renewal [ ] Commercial [ ] Residential [ ] Email Address: dodiecygan@comcast.net <br /> Business Mailing Address: 82 Horseshoe Bend Way Mashpee, MA 02649 <br /> Business Telephone: 508-539-0099 Home [ ] Cell [ ] Phone: 508-539-0168 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Melissa Cyean <br /> certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> W.l <br /> all state taxes as required under law. <br /> Q, At,4'� '�6 -D 6 49 to&'S <br /> *Signature of auth ized a **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 ismade under the authority of Chapter 62C,§49A Massachusetts General Laws <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE: ss DATE 0-Cembea ao14 <br /> Personally appeared before me the above-named m_elt•s s.c, Cv 4�n and made oath that the foregoing <br /> statement is true. <br /> A ceni(icate 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'meY �f^ tel °\ <br /> otary Public Commission Expires <br /> Margaret C. Santos <br /> CortunweaMh of Massachusetts <br /> M Comnitislon Ea res on Se t 22,2017 <br />