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` BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE 7 / o 1 <br /> DATE <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 c <br /> Business Name/DBA: s) L�/ �}(E Corporation Name: 51 A PL%e TjL` Fi'r L X . is conducted at <br /> Business Location: Lt '7ty S 1JLLZf— 02A7T. <br /> Business Mailing Address: <br /> Business Type: /V-&79A-1L FA,-0ja 1 JljW_6.w Business Telephone: <br /> Home Phone: Email Address: 17"e-/C 5A N%e e- l!4&"e 3 CcA—I <br /> by the following named persons: ^7�- <br /> er Residence <br /> - / 6a'y OwIn�L�1TV lb /� vnCAQe(eCbca,X /&M/- <br /> /���,� <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 /> 3 ?37� <br /> •nature of authorized a ent "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 /> NAME: TELEPHONE NrUMBER: <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 Conuaonivealth of Massachusetts 2 <br /> BARNSTABLE ss \ ,, ) �1 DATE <br /> r" <br /> Personally appeared before me the above-named J A S 0 J ( 0Z 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 /> EP. <br /> • <br /> Nilftfiiliftblic COIGIONWEALTH OF t4AS&1CNIWEM <br /> SEAL My <br /> �� <br />