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-26 1 Llo d pp- <br /> • BUSINESS CERTIFICATE <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE DATE -7 ) /6/JD <br /> � 20 / <br /> Expiration Date: <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 under the title of �`` J � (,)� / <br /> Co 4f_^, P't &JA DBA V `rc-Ptn ) Irq�� / tetJAI- �aE. is conducted at <br /> 5oJfli ,APV_ P f 7-et. <br /> Business Location: `a� Gd V.olorC.'& I S I— �1 a Sft 0 eg- <br /> Business Mailing Address: Mo Ag4olk& / A Jw1dJ'E 1 /' I�} Q a OS�J <br /> Business Type: &t>dWdf Y_ ke. R r ec'111QBusiness Telephone: s� '� 6 ' 3.33 <br /> by the following named persons: // <br /> FULL NAME <br /> fee-& RESIDENkdCE <br /> (.o . l- • I1eJac Gic1� ( 36 �sl�'J we.f . / of <br /> Home Phone: S) Sfo&— 33 3 g <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 /> 0 as required under law. <br /> 'Signature of authorized agent email address <br /> "*Social Security Number <br /> or Federal Identification Number <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 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 BAILVSTABLE ss DATE - (� <br /> Personally appeared before me the above-named and made oath that the foregoing statement is <br /> [rue. <br /> A certificate issued in accordance with this section shall be in force and effect or four years from the date of issue and shall be renewed <br /> each four years Ivcreafier so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed 1 up <br /> • SA o(ary NN :Ly <br /> SEAL COMMONWEALTH of M,SU3HUBETTS <br /> �St <br />