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r <br /> BUSINESS CER"1'IFICr\TE# IQl <br /> 'f • n <br /> TLIE COMMONIVEALTH OF MASSACHUSETTS 1 <br /> TO IVN OF MASHPEE <br /> • DATE <br /> Expiration Date: v f <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 Nantc/DBA: S IeNlT (�� LCorporation Name: i /y{L.1'C/L RO T V UX/ is conducted at <br /> Business Location: l 1T W �}�,�) /�/�,{� <br /> Business Nlailing Address: 'FD �X 2�2� ` Z\ 6 Q A <br /> Business Type: '`A'u� _Business Telephone: So$ �� �— IZ 1 <br /> 50b 280 are l' LA-Mk S`I� Irl.` <br /> Home Phone: Email Address: . <br /> � Q- J <br /> by the following named persons: <br /> 144 !iaU!C"C 0 o CLOtT M:& <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 unde law. <br /> 4 D�r3le1 g1�5°I <br /> matt of authorized agent **Social SecurityNumber(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 C,� <br /> NAME: � SS� vQsue TELEPHONE NM <br /> LBER:01B 2" �6 1 <br /> AlarmCompany: T altm otQ Wf�' <br /> **Your social security number will be furnished to the L'vlassachuseus 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 oaunonrvealth ofhlnssaclu setts 0-2d <br /> BARNSTABLE ss DATE Q <br /> Personally appeared before me the above-named and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section shat a in force and effect f four years from the date of issue and shall be renewed <br /> each four years thereafter so I ng as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed O / <br /> I <br /> • SEAL JOSEPH L. <br /> wayam <br /> bam.rss sola <br />