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BUSINESS CERTIFICATE# !�2O �� oa�� <br /> y. <br /> / J THE COMMONWEALTH OF MASSACHUSETTS <br /> TO IVN OF MASTTPEE 'L Z�6 Zo <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 <br /> Business Name/DBA: Corporation Name: 00`(- is conducted at <br /> ,, I1 l <br /> Business Location: 36' NIC- L $/'W�(Cr <br /> Business NlailingAddress: �Po �jOX lq�l� VOi7 �IrAA 02�3s 6 <br /> Business Type: 7 ty Business Telephone: 5619— 2-0 -07157 <br /> J ' <br /> Home Phone: S`D�'533 Io20 Email Address:_. <br /> o(A, Prkoor\ ,A_- rtc , <br /> by the following named persons coy" <br /> l <br /> Own e Name Owner estdence cc I <br /> 116 U` A- 60K� oZ6q <br /> I certify under th 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 requ- rider law. <br /> O4 -3522-2120 <br /> d <br /> gna r t agent c GSA' ""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 /> N qj Ig; y >µ �'• TELEPHONE NUMBER: 7U D -7-2I�(I <br /> AlarmCompany: <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 <br /> BARINSTABLE 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 />