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BUSINESS CERTIFICATE # <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE Lu.LCF,.0 <br /> • t <br /> Expiration Date: aCIQc.�� 31, 90/ Y <br /> i <br /> In conformity with the provisions of Chapter 110,§5 of the Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title 1 <br /> Business Name/DBA: Corporation Name: <br /> is conducted at B siness Loc ' n: Commercial— Residential_ <br /> Business Mailing Address: Z <br /> Business Type: J/"'9423�/, A4 1,0" Business Telephone: sc7g 2o�S4y90 <br /> New Renewal [ ^] Home Phone: s S( 209 �9 �/ <br /> Email Address: �S�F��� 7,co w <br /> by the following named persons: <br /> OwnerNameOwner Residence <br /> Second Owner Name Second Owner Address <br /> Otify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as required under law. <br /> - y7- / J-5- 7P05 <br /> *Signature of aut*zag nt "Social Security Number or <br /> or Federal Identification Number(Required) <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 tar filing or tax <br /> payment obligations. Licensees who fail to correct their non-tiling or delinquency will be subject to license suspension or revocation. This request <br /> is made under the authority of Chapter 62C, §49A of Massachusetts General Laws. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss r DATE g'k' 001 LI <br /> Personally appeared before me the above-named t>ro n '3i 1' (� 1'u -r and made oath that the foregoing statement is true. <br /> A certificate issued in accordance with this section shall be in force and effe t for four years from the date of issue and shall be renewed each <br /> four years thereafter so long as such business shall be conducted and shall lapse and be void unless so^renewed. <br /> �ned <br /> Notary Public otary Public <br /> Margaret C. Santos g - <br /> CommonwBallholMassaehusetls Commission Expires: <br /> My Commission Expires on sept.99,0117 <br />