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Y: BUSINESS CERTIFICATE tto24f o <br /> T HF_ COMMONWEALTH OF MASSACFIUSCTTS O <br /> 7'O I'VN OF HASHPFF_ 7/` D <br /> • DATE <br /> Expiration Date: I <br /> fn 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 <br /> Business Name/DBA:yl1IUI W �Coor porration Name: -OS [ I4n�S MGc)h�eeis conducted at <br /> Business Location: ig \ W v+ I as loPlo- , e <br /> IIN <br /> Business 7ailing /� <br /> Address: - l Q rn <br /> Business Type: SI_l��7& I Business Telephone: <br /> Home Phone: (oil ({/J / Email Address: <br /> by the following named persons: <br /> l00nn� �sFarrluoho C, l �. i esiderici CICJIP <br /> rn� <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 /> s required and r law. <br /> etre of authorized agent **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> i <br /> NAME: TELEPHONE NUMBER: <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 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 /> Q <br /> The Canntannealth of Alassaclutselts <br /> BARt\'STABLE ss DATE -7 <br /> Personally appeared before me the above-named�d pAyv,,,y V*ST' AA L UaWmade 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 fo thereafter so long as such <br /> business shall <br /> be conducted and shall lapse and be void unless so renewed. <br /> Sign I 1 I 1C�l�1 LUI IIU.1 r� <br /> • SEAL NotaryPtAAt <br /> cwttwtlwE,unl of wteanettw <br />