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N' BUSINESS CERTIFICATE THE COMMONWEALTH OF MASSACHUSETTS TOWN OF MASHPEE DATE 6ZIlt /-Z- Expiration Expiration Date: 0D-1121 1 In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the undersigned hereby declare(s)that a business under the title of l� Business Name/DBA: -('1C✓ A',c'-cgQLS�)"CCorporation Name: ^ is conducted at - Business Location: Z 6a'L 2tit' /�,tV`t`'S P- . AAA 0 Z6y 5 Business Mailing Address: IZ g`LL � �' /"`�`S�� MA 0Z64/el Business Type: Business Telephone: SUB 7 7 511 Lk U 1 Home Phone: 50D 7 76 5-1 y U Email Address: f: by the following named persons: Owner N�me Owner Residence I��c�lArrl� l \V C\. L yZ 9..24c od A&et Apzz ", VkA a161f I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state taxes as required under law. gnature of authorized agent "Social Security Number(Voluntary) or Federal Identification Number *This license will not be issued unless this certification is signed by applicant In case of emergency j NAME: TELEPHONE NUMBER: Alarm Company: I **Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Massachusetts General law,Chapter 62C,Section 49A. The Commonwealth of Massachusetts BARNSTABLE ss DATE r;2-1q-401;Z Personally appeared before me the above-named d Z�§hp.r C6 and made oath that the foregoing statement is true. 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 each four years reafter solong as such shall be conducted and shall lapse and be void unless so renewed. Signed Notary Public -RSEAL • �. n Commission Expires: r� �