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r BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS Y <br /> • TOWN OF MASHPEE �3 <br /> DATE <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declar s) that busigqness under the title of�f <br /> O. <br /> Business Name/DBA: °` W 124/7*-- rporation Name: is conducted at <br /> Business Location: <br /> /!r ��' 6 �iyv� 7.q. t /1'tfht /tt /L1fI OL6y9 <br /> Business Mailing Address: <br /> Business Type: (� s /i'���^� Business Telephoner: .�X S3l ' 0`3L 7 <br /> Home Phone: ��' 5 39 /9�/ Email Address: !J i �; 5— _-l Cl yl `iel- <br /> by the following named persons: <br /> Owner Name Qwner Residence <br /> Ale✓ /� �,J��i /JtftnE T �,jscl <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 /> t es as requiredunder law. <br /> at a 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:✓J�✓t 'l(r./ TELEPHONE NUMBER f <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 subiect to license suspension or revocation. This <br /> iEquest is made under the authority of Massachusetts General Law,Chapter,62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> 131ARNSTABLE ss DATE LOl <br /> #; Personally appeared before me the above-name l, and made oath that the foregoing statement <br /> ts'irue. <br /> :r A certificate'y ued in accordance with this section sh be in force and effect for four years from the date of issue and shall be renewed <br /> each fou year ere.( r so long as such business shall be con ucled and shall lapse and be void unless so renewed. <br /> Signed <br /> [/Notary Public <br /> SEAL <br /> EL <br /> Z. ssion Ex <br /> BPARtwJ_______An <br /> i0 nilv3N640mm <br /> W�N <br /> 7 Hd380P <br />