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BUSINESS CERTIFICATE 20 <br /> TOWN OF MASHPEE <br /> • Date: / / Z <br /> Expiration Date: 113t <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as <br /> amended,the undersigned hereby declare(s)that a business under the title of <br /> //o �/� <br /> Corporation Name: I`I RNVI F .TnC Business Name/DBA: A-II Goob <br /> is conducted at Business Location: I ph CD In I EQ U Ma 5 kp-e-e M A two yQ <br /> Business Type: P12�C�1 � — C�o�htn9 Q11Ly CtcfoQ SORIeS ' <br /> New[✓]-Renewal [ ] --Commercial <br /> [ ] Residential [ j Email Address: ahe le o2 a yQ m <br /> hoo •Ca <br /> Business Mailing Address: �b GV X U 6TQ ShtMe I MA/ A Q Z6�-JQ <br /> Business Telephone:71 Q'- Home [ ]Cell P1 Phone: 77 L4 -7ac;� — I/Q� <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Pe(1Ka Zheleva 36 C hale IQO <br /> M �m hi I i RKoy :5n nolwlck t M <br /> I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all state taxes as required under law. <br /> -t1 . L> �-lck.;c 12 ala 15301,2 <br /> "Signature of authorized gent "Social Security Number(Voluntary) <br /> -This license will not be issued unless this certification is signed by applicant or Federa l Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> r— <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 subiect 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 O f� <br /> Personally appeared before me the above-named P z <br /> Kok hele.va and made oath that the foregoing <br /> statement is 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 <br /> renewed each f rye ars 1thereafter soo�lo`tftng^such business shall be conducted and shall lapse and be ch unless so renewed <br /> Signed 11 M<<�T/ ll __ Notary Public <br /> Commission Expires <br /> Deborah Dami <br /> o� NOTARY PUBLIC <br /> Commonwealth of Massachusetts <br /> My Commission Expires July 29,2016 <br />