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BUSINESS CERTIFICATL# C;CJ/a' 077 <br /> G1 THE COMMONWEALTH OF MASSACHUSETTS I <br /> TO IVN OF MASFIPEE ?Q�� <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 under the title of <br /> Aly 6aJ_11_10 - �d-Vccalz' <br /> Business Name/DBA: z�acfaLi Cy ,ICorporation Name: � � ,fit �1 is conducted at <br /> Business Location: ���tC� /a1 ur / /o��ee �`47 02(0`Tg <br /> �t <br /> Business Mailing Address: �p7 <br /> Business Type: C0/�SGI fit!✓yC/ Business Telephone: � • �a D. 80&(5 <br /> Home Phone: Entail Address: / t . V VOS a0 CO <br /> lrVI <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> L 13La6k a b0lle— <br /> I certify 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 /> taxes as required under law. <br /> IFdnantre 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 A/rtssuchusetts <br /> B.4RNSTABLE ss �J DATE 10 L3 (J <br /> Personally appeared before me the above-named , - 2 /� �A-�,1� 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 shall be conducted and shall lapse and be void unless so renewed. <br /> -/-Signed <br /> • Notary Public <br /> l SEAL <br /> =J0SEPHtoMAWX0K4"JR[l "JRPublicF blit HUSEiTBm Evires <br /> 5.201& <br /> A <br />