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J <br /> Y BUSINESS CERTIFICATE# 1-1 —"L-10? <br /> THE COMMONWEALTH OF MASSACHUSETTS II I <br /> TONIN OF MASIIPEE 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: H (4'11 bLOCV� Corporation Name: is conducted at <br />� Business Location: 2Z FALMoJS 0 KO <br /> Business Mailing Address: 5 Flmf.. <br /> Business Type: f. PR I C `L-rc Business Telephone: SOS - 4l? <br /> Home Phone: '�'�� 'y I� - �' t Email Address: m IC N A EC . "TOICL _ 1AR6 LocK, CO!'\ <br /> by the following named persons: <br /> Owner Names Owner Residence 92 <br /> (1'11 C_ ( ICL lC,1CC.-('S 21- boo WG t4flt� <br /> Spor3 % CM HR D2S63 <br /> 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 <br /> taxes as required u er law. �. <br /> 2(,- ` EZ? <br /> j *Signature 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: K A i�r T o 1,-L O- TELEPHONE NUMBER YJ) " R 3 S- q <br /> iAlarm Company: ' <br /> **Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax fling or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subiecl to license suspension or revocation. This <br /> request is made under the authority of Massachusetts General law,Chapter 62C,Section 49A. <br /> The Con:nionwealth of Massachusetts DATE A- 1(0 - qq <br /> IiAKNSTABLE ss <br /> > appeared <br /> Personally before me tile /��e above-named 0 vt a CN A"'L Towl'A and made oath that the foregoing statement <br /> is 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 �„� Sawa <br /> LA <br /> ' Notary Public <br /> SEAL DebMh 09kMi <br /> &MVCcC,0MmmWWEP*0J*29.2M' <br /> NOTARYPUSUCCommission Expires: <br /> r1 <br />