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BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE py- 131 <br /> • I <br /> Date: / 3! <br /> Expiration Date: ! 3t O <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 /> Corporation Name: (s1DhaJ MO&E110&DUD CDrU- Business Name/DBA:AJJbVVn M�C <br /> is conducted at Business Location: SIAS fi11ma]+h%0A �N1 Shpu. MR oa[nyq <br /> Business Type: G1C1S�Y1 /LbY1'Vmence- Stoy-r <br /> New [ ] Renewal EA--Commercial [Residential [ ] Email Address: <br /> Business Mailing Address: 11 C•'1ArQV T St 14re 4a5;WA1+h ayn N'1A _03q'51 <br /> Business Telephone: Home [ ] Cell [ ] Phone: S$-1411- 1,962 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Cslohal MontelloftUn (hm. 40g1 Nyy%=Sk u.(kcLlaS <br /> W&RIKetM. MA Q45-1 <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 t equired undeaw-M0b6d H0f1W100nT`30T- <br /> UU�I 04 •�4U�oo[8 <br /> i ure of author' agent by:An yMG11Ka'&9 "Social Security Number (Voluntary) <br /> *This license will not be issued unless this certification is signed by applicant or Federal Identification Number <br /> In case of emergency <br /> NAMEA; t1h'1 Uu l __ TELEPHONE NUMBER: Lim- 1 -4-4- (ou":m <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 1 I I !ILA <br /> Personally appeared before me the above-named PrllWI _f LkD SII y—/ /t&, and made oath that the foregoing <br /> statement is true. <br /> A certificate issued i rdance with this section shall be in force and effect for four years from the date of issue and shall be <br /> renewedc our years there cr so long as such business shall be conducted and shall lapse andbe <br /> void unless so renewed. <br /> • Signed Notary Publicc."'�l (J <br /> STACEY A. 1 Ffi Mlion E pires l/ <br /> o.p Notary Puic <br /> COMMONWEALTH OFMASSACHUSETTS <br /> My Commission Expires <br /> September 23,2016 <br />