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TOWN OF MASHPEE BUSINESS CERTIFICATE <br /> • Date: I U Ill 1 <br /> Expiration Date: IO/31�a01�X. <br /> In conformity with the provisions of Chapter 110, §5 of the Massachusetts General Laws, as amended, the <br /> undersigned hereby declare(s) that a business under the title of TIN Name/DBA: Captivating Canines Corporation Name:DdraYl S �t ` <br /> is conducted at Business Location: 439 Nathan Ellis Highway,q6 Certificate No. 2010-009 <br /> Business Type: Dog Groominng Cao)Ja( ),LyCQnikt.�M�ll <br /> �;p <br /> New [ ] [ ] Commercial [ ] Residential [ ] Email Address: f . <br /> Business Mailing Address: 439 Nathan Ellis Highway, Unit 6 Mashpee, MA 026449 <br /> Business Telephone: 508-477-4885 Home [ ] Cell [ ] Phone:So?- a_q v� /S—z:)F <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Shauna Gonsalves 2A Route 130 Sandwich MA 02644 <br /> certify u4the (ties of perjury that I, tothe best of my knowledge and belief, have filed all state tax returns and paid <br /> taed oder law. <br /> S ( ia,- IS'71 <br /> tgnaturized agent "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: / V TELEPHONE NUMBER: <br /> Alarm Company: 1 " <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 Chapter 62C,§49A Massachusetts General Laws ^/h3 is- <br /> Tit o� / J <br /> BARNSTABLE: ss el_ - /� DATE <br /> Personally appeared before me the above-named C�Ylf�U ", LT-"154 1'V-'e S and made oath that the foregoing <br /> statement is true. <br /> A gerlificate issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be <br /> renew a four ye-us there a so loo as such business shall be conducted and shall lapse an yo'd unless so rene%�(e$. <br /> •Signed � g Notary Public �+ <br />! <br /> OMY <br /> Deborah Darr i Commission Expires <br /> NOTARY PUBLICCommonwealth of Massachusetts <br /> Commission Expires July 29,2016 <br />