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r •' <br /> BUSINESS CERTIFICATE ;•df L/ �G <br /> ie TOWN OF MASHPEE <br /> 2 ` ( l <br /> Date: > <br /> Expiration Date: <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 /> /� (� ��y't�r�Z"aa- <br /> Corporation Name:l ,01Q. t UV <br /> 7�Tdi_-K(tQu us es�snN"ame/DBA: <br /> is conducted atBusiness Location: (0 &Am' la <br /> Business Type:l/ LUr�.Lt.:l`{ N <br /> t <br /> New[Renewal [ J--Commercial [ J Residential J _] Em�ail Address: L?/1/JhQ . (d C41/�(�G .( 3l� <br /> Business Mailing Address: Cly{trHY1l L / ( � ,YA • '-t yy-) <br /> Business Telephone: 1�'q(d I ] ��� —Home [ ]Cell [ ] Phone: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Lie <br /> • V�J�2AA_ ��`, CZA RMP LP b� l r'�c i M a Sly►°e�'> lu+t <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 required under law. <br /> �'�-moi ��'� • \.el.e - '�'�'1l0 <br /> *Signature of authorized agent "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 /> NAME: TELEPHONE NUMBER:/Vl��` ' o� 1 2— <br /> Alarm <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 sublect 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 n DATE <br /> Personally appeared before me the above-named 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 four years thereafter so long as such business shall be conducted and shall lapse mid be void unless so renewed. <br /> • Signed Notary Public <br /> Commission pi A1CGN <br /> NOTARY PUBLIC <br /> caaaoRweulR OF NhSS40HUSErM <br /> My Comm.Expires Oct.16,2020 <br />