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} BUSINESS CERTIFICATE hi�01.5-OD5 <br /> TOWN OF MASHPEE <br /> • Date: <br /> Expiration Date: <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 /> i <br /> Business Name/DBA: Cape Kids Therapy & Sensory Center Corporation Name:�fz� 1 � l )�C �✓�� <br /> is conducted at Business Location: 681 Falmouth Road, 1324 Certificate No. 2011-001 <br /> Business Type: Ocupational TherapRty <br /> New [ ] Renewal [A Commercial [ ] Residential [ ] Email Address: madeline@capetheraphynetwork.com <br /> Business Mailing Address: 681 Falmouth Road, #1324 Mashpee, MA 02649 <br /> Business Telephone: 508-737-3490 Home [ ] Cell [)C] Phone: 508-539-3436 cvto^"-�) <br /> %3vS1�ss — -7K-7 -52.1 - 3 -4 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Madeline Lanfley 1 Fox Bottom Circle Sandwich MA 02563 ' <br /> it certify under the penalties of perjury that f, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all state taxes as required under <br /> �0-$g3931cl <br /> *Signature of authorized aged[ "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 /> '1't'1G cQ.C.l�ns. oT <br /> NAME: L TELEPHONE NUMBER: SDS— 73-7-3 `/`7O <br /> �� b L—1 — X533-0805 <br /> Alarm Company: <br /> i <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 Commonwealth of Massachusetts 1 <br /> BARNSTABLE: ss DATE 1 C1." uI x Lr Fc_t 2,01� <br /> Personally appeared before me the above-namedand made oath that the foregoing <br /> statement is true. <br /> A certificate issued in accordance wi t this section shall be in force and effect for four years from the date of issue and shall be <br /> •renewed ach four years herea@ r so long as u h business shall be conducted and shall lapse and b oid unless so r(Qenewe <br /> Signed Notary Public U0,& -al �QA'_; <br /> Deborah nission Expires <br /> NOTARY PUBLIC <br /> Commonwealth of Massachusetts <br /> My Commission Expires July 29,2016 <br />