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BUSINESS CERTIFICATE N 10- 0 IJ <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE0 <br /> DATE U <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, s amended, the <br /> underst tied hereby declare(s)that a business under the title of T <br /> �����-� \ x MCk-- � DByA�� \C\dl��� 5 CA_ I 'I� W/J�I'/�1Q jis conducted at <br /> Business Location: \�SVV yA 0 I0 -1q <br /> Business Mailing Address: ?C J J'-" � t� t 11C�� Pe-r ( 't'L-VT Q U�10 V9 <br /> \ [— � [. L / <br /> Business Type: ffC^^�G-���r��� Business Telephone: l G / �(o U <br /> Home Phone: <br /> I <br /> by the following named persons: <br /> FULL NA1LRESIDENCE cxresn a� m��,L W-00939 <br /> I <br /> Aftcertify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> xes s required under law.nn ,^ ^• <br /> � I U l.�/l-l�-� <br /> *Si nature of authorized age— *Signature of authorized agent <br /> 64 y0 a l D �- <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> ( � In case of emergency n �/ t� {� <br /> NAME: NCS- "." TELEPHONE NUMBER: S— '/ 7 O '(30 <br /> Alarm Company: J1j In'1 <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 mel lax filing br lax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subiect 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 <br /> BARNSTABLE ss c DATE <br /> I <br /> Personally appeared before me the above-named fL�"*' /�and made oath that the foregoing statement is <br /> trne. <br /> A ceni6eme 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 /> i <br /> Signed <br /> 0 •� T I r.•` Yn <br /> SEAL e t- Notary Pubtic <br /> COMMONWEALTH OF MASSACH <br /> ^ ��5�r�japires: <br />