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"M BUSINESS CERTIFICATE#L53 <br /> ME COMMONIVEALTM OF AIASSACMUSETTS <br /> TO MV OFMASHPEE L / <br /> DATE <br /> Expiration Date: 3/ to <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned �hereby declare(s) that a business under the title of A/ <br /> DBA /!/ r� is conducted at <br /> Business Location: -Z— *Z' Z-3 <br /> t) <br /> Business Ntailing Address: <br /> ^ ,�,/ <br /> Business Type: MJ,l�lL��� Business Telephone: 77 <br /> Home Phone: <br /> by the following named persons: <br /> )FLILL NAME RES.11D C <br /> I certify under the penalties of perj that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> Alh:es as re tired under la v. C <br /> *Signature of authorized agent "Signature of authorized agent , <br /> J Zi - /7Z GO / ;? <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency -•- j <br /> NAME: ./�T I/l N� TELEPHONE NUMBER / 7[� <br /> I —31z—MW <br /> Alarm Company: <br /> '"This license will not be issued unless this certification is signed by applicant <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request <br /> is made under the authority of Massachuseus General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts 3 ��-'/q7k)/0 <br /> BARNSTABLL' ss DATE <br /> Personally appeared before me the above-named 0,JCX— <br /> true. ���/S and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accorda cc <br /> with this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years thereafter so long as st business shall be conducted and shall lapse and be void unless so renewed. <br /> �ned <br /> SEAL <br /> tt��e��7II0!, <br /> JRtHplmt Expires.2ota. <br />