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BUSINESS CERTIFICATE# �20/1- <br /> • ,. THE COMMONWEALTH OF MASSACHUSETTS f t 1 3 d t L <br /> TOWN OF MASHPEE <br /> DATE /ty�nl <br /> /) <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 A <br /> Business Name/DBA: PAV4:L 11f&01 5iTt2�t $'-M 21 Nc Crporaattion Name: <br /> is conducted at Business Location: -3(7 /1l/C Ot &"T TFJ r S Lt/AY Commercial .W' Residential_ <br /> Business Mailing Address: 3L-, / i-OL -7T?g s SU/ 715 <br /> Business Type: UPHU i_ %n� Y Business Telephone: S Oe- S_3 - // .3 S <br /> Business Phone - Home Phone: �7y- q19- X87% Email Address: f'A1)(' t/F//Cf-$7�-/�Iy. <br /> 60M&AS7; NcT <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> 7i/L F EmE>zso.'J / r SKA'Tinl e, a1Aw ✓2h <br /> flY_S /W /q !9LlvO / <br /> I certify under the penalties of perjury that I, to the best of my knowledge and belief, have fled all state tax returns and paid all state <br /> taxes as required under law. <br /> Z7- <br /> nature 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 fumished 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 Coaupoatvealth ofMassachasetts <br /> BARNSTABLE ss (//��A j' DATE <br /> Personally appeared before me the above-named t /-`()(- /� Sd &4� and made oath that the foregoing statement is <br /> nue. <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 /> 777 <br /> ftr <br /> ary Public <br /> SEAL <br /> QOSOMMU WiMCCHELU,JR <br /> uW':-_',uOAtcommONWEAL.' <br /> �F SS�dy8ETT8 <br /> t,tyt.ea�'1IL55i0fIEJfppgs <br /> October 25,7.01 , <br /> _J <br />