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A' BUSINESS CERTIFICATE# 10-5< <br /> THE COMMONIVEALTH OF MASSACHUSETTS <br /> • TOWNOFNlASHPEE L]/ 1,4Z <br /> I �b <br /> DATE <br /> Expiration Date: <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 tinder theeCtitle of <br /> �, f[ )► AQ r�KJ(� DBA (3NC9C TN= t'�Cr COIU.jMfr conducted at <br /> Business Location: a ' I br— &�kpc;e M OQ Q <br /> Business tvlailing Address: Suic., �( JBusiness Teley �UV JBusiness Types: p <br /> Home Phonc: J = -_7q 1-7 1I <br /> by the following named persons: <br /> RESIDENCE <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 all state <br /> yes as required under la v. <br /> j L"'§ignalure of authorized agent "Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency �] <br /> NAME:I�CISIF��.S \VA 01� TELEPHONENUNIDER: -�71—+ 9I7 <br /> i I <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 Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts I / a I0 <br /> BAI2NSTABLE ss �j�� n(� y��+�� DATE —'I V <br /> Personally appeared before me the above-named sA na 1 G t"`� I and made oath that the foregoing statement is <br /> 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 renewed <br /> each four years thereafter so long as such/business shallshall ha ducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • oc""cc�� VIQNst�l I <br /> SEAL Notary Public <br /> COMMONWEALTH OF MASUCH <br /> : <br />