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BUSINESS CERTIFICATE# ad/8 r n 7 S <br /> THE COMjVIONfVEALTH OF iVIASSACHUSETTS <br /> TOWN OF AIASHPEE DATE <br /> • Expiration Date: 3 t <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 <br /> Business Name/DBA:, /-///'d�1T-�1 e/ orporation Nam/e: SL��'ti is conducted at <br /> /,5`3 <br /> Business Location: & //7 .ST �7laS`i/k� IWW 6V2 <br /> g /53 QST �iashde� Irl 0-26yg <br /> Business D7ailin Address: <br /> � <br /> Business Type: 7.,(',L�i1/�] U� Business Telephoner: "wa D _S �,,.��t d 3 <br /> Home Phone: J!/ �/J�f ? l� Email Address: _ 'j9*//�4z'o0 . LdX" <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> �or»(Z �o .94, r /5'3 f�7�Llin sT Q�t r�e� w6 5'9 <br /> I certify tinder 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 /> tax equired under law <br /> antre of authorized agent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <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 Alassac/urserrs <br /> BARNSTABLE ss V (1 DATE <br /> Personally appeared before me the above-named ( VO/UvL)trZ. f'r and made oath that the foregoing statement is <br /> uvc. <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 thea er so long as such usiness shall be conducted and shall lapse and be void unless so renewed. <br /> Signed �(Q Lli✓J —_ <br /> i <br /> • ca <br /> SEAL JOSEPH L'. N.EW.Notary Put>Ve <br /> L1H OF►UtiB�CMNE?If <br /> IAyCC®II a M 201res: <br /> 2y,1p1S. <br />