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BUSINESS CERTIFICATE# 0' <br /> THE COMA10A IVEALTH OF MASSACHUSETTS <br /> TOIVN OF MASHPEE <br /> DATE -: 8"011-06461�: S 13010 <br /> Expiration Date: o <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 /> 3 <br /> Business Nanle/DBA: 71:3 d0WSCtM1 4 <br /> Corpora_tion Name: Sr[3 OOITSCLH7/CLf is conducted at <br /> Business Location: �Ry -J(ciyoQ. QL P6& ti7)�a,5haee- <br /> Business \Mailing Address: �'SQvtn e. <br /> Business Type: �GC!'Y1tfLT./5/I2fl [.-FJYI�-U��111T�BusinessTelephone: C50e) J10—/C?V!? <br /> Home Phone: �. � ��� -OJT�{'� Email Address: 5 loddeP-LV/CZ 0 41QLI00. C+Or1ir <br /> by the following named persons: <br /> Owner \Name Owner Residence <br /> OU6a.vi T /ee�elce��/cam 07_ , a 'ledad� )Y[aah�ec <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 /> taxes as required under <br /> law, ' <br /> �G(9Q/t V •f.L(�1 <br /> gnattre of authoriz 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 /> Ra <br /> In case of emergency <br /> NAME: /r.()(�PJZh kT, &141 _-eW/if z TELEPHONE NUMBER:(5a) Y ?';2-05Y-� <br /> Alarm Company: Y)0Y?C1 <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 ofMassacluusetts ( / Zo/O <br /> BAILYSTABLE ss L �QDATE��_ <br /> Personally appeared before me the above-named • St tSan T &(I?Ag a /C-zand 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 vears thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed a q <br /> Nolic <br /> SEAL.. <br /> oOebmh oaffo Commission Expires: <br /> NOTARY PUSUC <br /> colmram"Ol v EjjM <br />