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BUSINESS CERTIFICATE#moi 3 -6 01 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> . TOWN OF MASHPEE I <br /> DATE <br /> I .ry <br /> Expiration Date: U / / <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: a `cI c /ir ax) ��,�fhs Corpeor'atiion Name: <br /> is conducted at Business Location: 5 tel/ d 11�G��Ll>q . /T 1(I IS k-ki Commercial—Residential <br /> Business Mailing Address: <br /> Business Type: <br /> 171bnod ev2 ,Seth/rI P Business Telephone: SoU p <br /> � 7y ?L3a- <br /> p JJ � ,/� — <br /> New [1-<Renewal Home Phone: 508 a g2 Email AddressArl {TI )Qh �6 Wl-l1UU <br /> UYYl <br /> by the following named persons: <br /> Oer N Owner Res' ence <br /> b(012dwnme I MIS C pills Ci.� a <br /> rk'o(abt� ry) <br /> I certify under the penalties cif 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. t <br /> AkC1_ da-_ 0r 7 4 4 aG 7s <br /> 'wgnature 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 <br /> Personally appeared before me the above-namedQw l7 M t—t- S 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 t after so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • Notary Public <br /> SEAL <br /> EEEO= <br /> My Cammisd3_W 20. <br />