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BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE <br /> Date: nfr a-A S <br /> Expiration Date: Q YJ ' <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 <br /> Business Name/DBA: B & L Floor Covering Inc. Corporation Name: <br /> is conducted at Business Location: 684 Falmouth Road Certificate No. 2010-105 <br /> Business Type: a�Reetail <br /> New i •I Renewal / Commercial [ ] Residential [ ] Email Address: olsonstyles.comcast.net <br /> Business Mailing Address: v 684-Faimouth Road Mashpee, MA 02649 <br /> Business Telephone: 508-648-9120 Home [ ] Cell [ ] Phone: 508-648-9120 <br /> by the following named persons: <br /> Owner Name t N Owner Residence <br /> Gene Olson 491--Ma4i--5treet Mashpee, MA 02649 <br /> �Icertify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all state taxes quir er law. <br /> *Signature of author) d 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: 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 is made under the authority of Chapter 62C,§49A Massachusetts General Laws <br /> The Commonweahh of Massachusetts <br /> BARNSTABLE: ss DATE� I S <br /> Personally appeared before me the above-named (Sgcje (ll S ori and made oath that the foregoing <br /> statement is true. <br /> A certificate issued in ace dance with this section shall be in force and effect for four years from the date of issue and shall be <br /> renewed each fo ears ereafte long as such business shall be conducted and shall lapse ad bye ovoid unless so renewed. L <br /> •Signed Notary Public Gt n� <br /> DWOF <br /> .CKLAND TRUST COMPANY nn <br /> 01'1304478 Commission Expires `�1 Dcx:) <br /> FOR DEPOSIT ONLY <br /> _' DEPT.N 400 <br /> ,TOWN OFMASHPEE <br /> 4860715 <br />