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BUSINESS CERTIFICATE#/0 -W <br /> • THE COMMONIVEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: Dece/nbeY 31, 201 y <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned"hereby declare(s) that a business tinder the title of <br /> ,,�uiLr.LC O'r-k/tij (Ci�� CGS/ DBA // is conducted at <br /> Business Location: (' Ly,,7 c 026 <br /> 2� ter <br /> Business Mailing Address: 8 ZY C[/ o/, /��,GSLJ l��j 9 O Z G �9 <br /> Business Type: /JOBusiness Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> /p�ias/Jj>d", /�r9 <br /> Home Phone: 5_08 S( G S'f/ );7S <br /> • I certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as required under law. <br /> "Signature of authorized agent "Signature of authorized agent <br /> 03Z - 80�- -/ra0/ <br /> *"Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: S'E���/I /� ��� TELEPHONE NUMBER: S09 SK,' 62-5-,7 <br /> Alarm Company: <br /> *This license will not be issued unless this certification is signed by applicant <br /> *"Your social security number will be fumished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing statement is <br /> 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 <br /> • each four,years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Notary Public <br /> SEAL <br /> Commission Expires: <br />