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BUSINESS CERTIFICATE# v d 41 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE �11116 <br /> Expiration Date: 3 <br /> In confomuty 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 b siness under the title of <br /> �� 9 � <br /> Business Name/DBA: /� Corporation Name: is conducted at <br /> GBusiness Location: -d A P \I P 6 a qe f p <br /> Business Mailing Address: kke- 2' R ��,Q, QIP y fQ55 CZA-9' <br /> &Business Type: &a 7� C(L1t Business Telephoner <br /> Home Phone: 568' 'yy1 - Email Address: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Ila 1 aNQ 1JjW MV' <br /> PAkf�LU(je M a M3 Z <br /> 1 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 /> nature 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 /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> **Your social security number .vill 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 Conuuo✓nvealthofMassachusetts ' <br /> BARNSTABLE ss ��. DATE J(�— l� u Ivl t L[-J1 <br /> true. //�1, <br /> Personally appeared before me the above-named� i and made oath that the foregoing statement is <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 p <br /> IAf�A r _I�1 <br /> U Notar ublic <br /> SEAL 1 Supp <br /> MIS IV Vl �LIC <br /> ICN <br /> Commonwealth of Massaehuselts <br /> My Commisslon Expires <br /> January 16, Nis <br />