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BUSINESS CERTIFICATE# /-L— 0� <br /> �_.. <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE et( 011— <br /> Expiration <br /> YExpiration Date: 1 <br /> I <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 D <br /> Business Name/DBA: 6796) D f-" D)� Corporation Name: <br /> Toyis conducted at Business Locations�I SIA �./I� Commercialk—Residential_ <br /> Business Mailing Address: IT�� 5�1 ( /Y/AS T7�7� CC � � 0.) (' " <br /> .) ' " <br /> Business Type: Business Telephone: <br /> ,/�AA �7 n � <br /> Business Phone 7 T Ja2_G /ddHome Phone: Email Address: 6�l q t"t14j(b)l <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> gQ >vo�b,�p m fs MES We-1 C47,4owA- m - <br /> I certify under the penaltiesof perjury that I, to the best of my knowledge and belief, have filed all statetax returns and paid all state <br /> taxes as required under law. <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 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 Counnourvealth of Massachusetts <br /> BARNSTABLE ss ,,{{ty//II �� f*� l LA�l DATE Ld <br /> Personally appeared before me the above-name67,?A jD s=o fw -K 0M land made oath 4t <br /> the foregoing statement is <br /> true. <br /> c ificate issued in accordance with this ec ' n shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four ars hereafter so long as such busin b onducted and shall lapse and be void unless so renewed. <br /> Signed La'y <br /> �["4 sq�.t� <br /> --- Notary Public <br /> SEAL <br /> pabptah Dand <br /> a� CAI S PUSUC I>< Commission Expires: <br /> w camfffts a+Willis July x9.x018 <br />