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BUSINESS CERTIFICATE#�dd''�a J — <br /> • TME COMMONWEALTF/OF MASSACMUSETTS <br /> TOWN OF MASMPEE N J <br /> DATE <br /> Expiration Date: I J <br /> Lm 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 brushiness under the title of `\ <br /> r��Npt��nv3�DBA` �!C�y M2 �1d s conducted at <br /> Business Location: <br /> q O� C c,�YV\Ot.I�M \CO nxk <br /> Business Mailing Address: Q r 0 • —\—:?-�O X <br /> Business Type: --\F'4�o �I��'-\�r�pr Business Telephone: 50� ' LA yyy <br /> Home Phone: 'Ein4 . LM • l.-1 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> V—Wt-v •�_l\ <br /> : <br /> I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax recurs and paid all state <br /> taxes <br /> as u d law. <br /> jk*Signature of aMorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number In case of emergency <br /> NAME: <br /> V e'tN Mars t� TELEPHONE NUMBER: F50%O$ 4`l l \l�lLly <br /> } <br /> Alarm Company: <br /> *This license will not be issued unless this certification is signed by applicant <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 ill be sm biect to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. /� \ \ <br /> The Cotnmonivealth of Massachusetts DATE 0 C a-1 to_TU\0 <br /> BARNSTABLE ss <br /> Personally appeared before me the above-named <br /> \/ ... _.,�,._ C 111ntS�r rS and made oath that the foregoing statement is <br /> me. <br /> A certificate issued in accordance with this section shall be in force and effect for(our 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 _ /�.... wr /1' )�1 t�Te.\\O <br /> Notary Public <br /> SEAL P —J a-O\� <br /> Commission Expires: <br /> _J <br />