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BUSINESS CERTIFICATE# 2t✓tt 2Q`Q <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE ` I <br /> ,DATE <br /> Expiration Date: t 7, v <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: �srnn,BL '61 ek�/1/.(��1W� 7' -rp ration me. <br /> is conducted at Business Location: J 4iFAr5/ftVD- &.,, Commercial—Residential_ <br /> Business Mailing Address: <br /> Business Type: [ 24d'a_//&Q Business Telephone: <br /> Business Phone Home Phone:( �����N(��_Email Address: <br /> �HOT/f//�/� • CD/!7 <br /> by the following named persons: <br /> Owner NameOwner Residence <br /> AD. �p� <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 required under law. <br /> *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: 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 <br /> BARNSTABLE ss DATE 42A2e b b, ai, _oG <br /> Personally appeared before me the above-named &�50r1 NB L. 1;0 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 ng as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> N ary Public <br /> SE <br /> _ Public Commission Expires: <br /> Margaret Notar <br /> C. Santos <br /> Commotnreab of Massachusetts <br /> My ClinniWiori Euplres on Sept.22,2017 <br />