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t . . <br /> BUSINESS CERTIFICATE WzoA- <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE I C2 /S /0 <br /> Expiration Date: �l 021 <br /> Ili 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 <br /> ..title <br /> eosf� <br /> t' l�(-MEL � -I�I�t�tsjQ�C,`{ .1��A11FQ�.1 fkr��p �i�NPg is conducted at <br /> Business Location: �)�a S_ME_PL9_ S ( /m��t411nSl�PE� MA 016401 <br /> Business Mailing Address: lox dL.1b I t *�M1n t42-9- (�A- f�©aj.,,45 <br /> Business Type: p <br /> 5rcR.`{ Business Telephone: So&-- 14-7, ' /2b1 <br /> V /�� <br /> Home Phone: 0w ' 401 <br /> by the following named persons: <br /> M�C �� FIJI LEVANIE <br /> y <br /> RESIDEEN <br /> i Ria ,V' <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 /> t e as equired under law. <br /> lure of authorize agent 'Signature of authorized agent <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> ���� In case of emergency <br /> NAME:TjoK)1PZA- f.r�>^1�.CS�`'' - _ TELEPHG NUMBER: <br /> 50� 4s1 - n4�3 <br /> Alarm Company: <br /> "This license will not be issued unless this certification is signed by applicant <br /> "Your social security number will be famished to the Massachusetts Department of Revenue to determine whether you have met rax 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 Alassachuserrs <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named a//r /JX IV /4CS t/m made oath that the foregoing statement is <br /> ue. <br /> A certificate issued in accordance with this section shall be in force and effect (or tour years gal <br /> the date of issue and shall be renewed <br /> each four ye th a iter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Sign <br /> • SEAL J EPH C ELLI,JR <br /> NOWry PWlic <br /> Ot:tohe2S,1013 <br />