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/ BUSINESS CERTIFICATE tt 0_y ll- oolo <br /> J THE COAlAfONI,itEALTH OF ilfASSACIIUSE7'TS <br /> TO MV OF AMASHPEE <br /> DATE 2 4 <br /> • Expiration Date: 20-6 <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 <br /> Ce� r <br /> BusinessName/DBA: tsconducted at <br /> Business Location: 1015 �s��'� �1e rk �1p C—E\� j M r�S�n.Q�S�tMLA <br /> Busincss \9ailingAddress: tRn /k ft <br /> Business Type: Business Telephone: <br /> Home Phone: 508— 4 11— Co000 Email Address: <br /> by the following named persons: <br /> t� \\ Owner Name ` Owner Residence p <br /> \`\t' �(jtr\ 1�a a it \C16 C'-ye R� 1.�P.c�k\c�,�1'ns Ayr <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 /> \A asz-V.rz\ 63 13� 4- <br /> Vulture of authorized agent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *"Phis license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE NU\OBER: <br /> Alarm Company: <br /> "four social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have ntct tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subiect 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 /> BARN'SPABLE 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 />