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BUSINESS CERTIFICATE N 10-Q <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOIVN OF MASHPEE <br /> DATE (\ �OI O <br /> Expiration Date: <br /> L/'3 ,0 `� <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as mended, the <br /> undersigned hereby declare(s)that a business under the title of <br /> �1 q aim <br /> �CZ/U Ai AL '6o a!/A/O O Wsk 11 // DBA p O�i0 d 71 eSS e� X77//'//!c-�GK is conducted at <br /> Business Location: �l'�' Rock K '(9-/Z) <br /> ,/ r <br /> Business iWailing Address: IK—C— �F A '6 <br /> BusinessType:/7J//1 /Q�G/Cd 6�T Business Telephone: S37f— 4 77— <br /> HontePhone: 'jlrf— SL7;7 — �arFc� <br /> by the following named persons: <br /> FULL NAIME RESIDENCE <br /> 60/UX-14— Qoc1-1 ,1y <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 /> 4L,Ne,as required under law. �/ 4 <br /> * ignature of authorized agent *Signature of authorized agent <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME/)/// V/� q0�N/f,U OGUSZ/ TELEPHONE NUMBER:, — �77— 6� <br /> Alarm Company: /y0 Al ef-- <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 susnension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts n <br /> Br\RI\STA.BLE ss (�� \ DATE (\fit- a1 r`10'0 <br /> Y pp _QC-)�\rCL, v 2pC'\`CL , foregoing Personally appeared before me the above-named t\t1.ib`l.\and made oath that the fore oin 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 shall be conducted and shall lapse and be void unless so renewed. <br /> fined <br /> � r <br /> r <br /> t bIc <br /> ' <br /> SEAL VICKI ANN ONI <br /> c(ftilifflW11 ORpNvm <br /> t*tY tlrNsslan Eq*es <br /> t0.2019 <br /> i <br />