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/ BUSINESS CERTIFICATEE #--V 13" all <br /> THE COMMONWEALTH OF MASSACHUSETTS P CR <br /> TOWN OF MASHPEE <br /> DATE � /3 <br /> Expiration Date: Y kf Z0� <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, <br /> the undersigned hereby declare(s)that a business under the title of <br /> Business Name/DBA: r'/iL t f � Corporation <br /> Naame: is conducted at <br /> Business Location: c<Street_>x Street_Name» ///iAiY/Tl�//�/I� &,, Z /x ,40.mmercial <br /> Residential r/ <br /> Business Mailing Address: <<Mailing_Address» iJA�I� <br /> Business Type: Business Telephone: _4 <br /> New Renewal rfHome Phone: Email Address: %�J / �U/��TiVGf��• <br /> by the following named persons: <br /> g Owner Name Owner Residence <br /> D14 z <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 <br /> all state taxes as r quired under law. <br /> 0�7— 36—s�/mil <br /> 'Si a t **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 <br /> 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 <br /> filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or <br /> revocation. This request 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-named (l Q�`r�h t �+ �-.0/ and made oath that the foregoing <br /> statement is true. <br /> A certificate issued in eeerd rice with this section shall be in force and effect for four years from the date of issue and shall be <br /> renewed each four yearj thereaft r so I such business shall be conducted and shall lapse and void unless so renewed. <br /> Signed / 5\ Notary Public <br /> • Commission Expires <br /> E& JMOSEP"L.MJRNotary PWGcNWEALTH OF <br /> My Corrumssbn Ewa Seal <br /> October 25.2013 <br />