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BUSINESS CERTIFICATE# <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> TE <br /> DA / y <br /> • Expiration Date: s c / <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`tittle of S <br /> BusinessName/DBA: KItCCoG� /�A`( F�Y��n },rc4til o�pplo atio`nName: <br /> is conducted at Business Location: -'t "`t' J dl`W liw) GI.' eDI /y fisaga—Commercial_Residential Z <br /> Business Mailing Address: �� <br /> Business Type:� 111(1I� ✓✓ _Business Telephone: <br /> Business Phone 1.l tel' �aa-�Jt) Home Phone: -71 ' aaa o�µ1��1 Email Address: <br /> by the following named persons: �je` QP ktc6iE�_M 616K>t TResidence <br /> 17,rNa;��Pt`L! -1N SvnerSl/�K��(_>�1.7 � , l� If$Nnl� <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 equired under law. C, <br /> mature 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 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 2-,BARNSTABLE ss DATE <br /> 1.4 <br /> -. .I a <br /> Personally appeared before me the above-named / yw /� and made oath that the foregoing statement is <br />� true. <br /> A certifica a 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 c s fter so Ian such Kusiness shall be conducted and shall lapse and be void unless so renewed. <br /> Siged <br /> i <br /> Notary Public <br /> • SEAL <br /> r� <br /> E <br /> Cres: <br /> Notary WFAITH S E)OfGsy Cyrurasyion F�jres <br /> OUOEat 25.2013 <br />