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BUSINESS CERTIFICATE# Z <br /> THE COMMONWEALTH OF MASSACHUSETTS P <br /> TOWNOFMASHPEE , �O <br /> DATE / o� <br /> • Expiration Date: tl—act 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 <br /> Business NameMBA: F(A-5Ll c Doe� Corporation Name: / <br /> is conducted at Business Location: 2 �C� � mm�eJrcial_Residential V <br /> Business Mailing Address: B2 E)2^ 7 <br /> Business Type /�T LBusiness Telephone:T(�� <br /> Business Phone C !/Amc Home Phone: .�`Yi�! Email Address: <br /> by the following named persons: ��l� 4"09/ <br /> 5� L <br /> Owner Name Owner Residence <br /> I certify under the penalties,4 perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as qur under 1 _ <br /> ��� r 5 oS <br /> ti f r e 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 riling 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 BARNSTABLE ss '�,n( - I DATE <br /> Personally appeared before me the above-named�t7��1`JtPJ iAJ 0 and made oath that the foregoing statement is <br /> true. <br /> A rtifica issue n cordance with this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four y r crc fler so n as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> No c <br /> • SEAL <br /> JOSE11H L.WA—MCC <br /> C&%%((``�� missilA4�Ripift <br /> NWEALTN OF MASSACHUSETTS <br /> My Commission Expires <br /> October 25,2013 <br />