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• - BUSINESS CERTIFICATE# e29/Z^ O to <br /> • TRE COMMON1,VEALTH OF MASSACHUSETTS <br /> TOWN OF MAS1/PEE Z I I Z <br /> DATE 2 <br /> Expiration Date: 1" L <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 n h Snpfe <br /> of <br /> IV,^ <br /> Business Name/DBA; Corporation Namca,`�Q.SaT1Un81 T`ljnrn� tQ is conducted at <br /> 1, ' �A� �h J� s�j <br /> Business Location: 1`�1 \1Va�r1f3)1 LI1�� T,�lrQ1��SiV�pP� IVKlshr1 c MR p0-4 \/�1� /�, <br /> Business Mailing Address: I15f/ Clyb� awe EasyTO���{�iou-1`�2 1p� A Qzss �_ <br /> BusinessType: <br /> V Business Telephone: SULU �.J I <br /> Home Phone: Email Address: -hY1�10-G <br /> I <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> AM!, M��o II Il6 Glob Value 1)V, Y rn�M1A <br /> vii. 116 Club I/rAllcH Dv, /= 641rna;7� <br /> I certify under the penalties of perjury that 1, 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 /> *�igna[ure of au�ized 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: 14%e uiM p 46'n f(o,✓ TELEPHONE NUMBER: d`C'S 9;rd y'�e 99 <br /> Alarm Company: A 0 7- <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 subject to license suspension or revocation. This <br /> request is made under the authority of Massachusetts General taw,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts 5 ^ <br /> BARNSTABLE ss DATE �- /2 <br /> Personally appeared before me the above-named Mr.v, �. 7 . 1 '11� Su f 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 soI ig as such business shall be conducted and shall lapse and be void unless so renewed. <br /> K-51-8 <br /> igned .—.KPAI 1 Imp <br /> ��ll , <br /> Notary Pu <br /> SEAL DebMh 0=i <br /> NOTARY PUBLIC <br /> Commission Expires: <br /> 29. 6 <br />