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t BUSINESS CERTIFICATE# <br /> / THE COMMONWEALTH OF MASSACHUSETTS <br /> TO JVN OF MASHPEE <br /> DATE <br /> Expiration Date: U <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> Ondersigned hereby declare(s) that a business under the title of <br /> Business Name/DBA: 1' 1lCottm�S PAII 4f NQ Corporta�tiion Name: is conducted at <br /> Business Location: 11-1— O 1 N P %242 <br /> Business iN4ailing Address: 6W C' e-&AI u-4,0001u-4,0001J17 �P <br /> Business Type:_7?j4_lnAA)6 Business Telephone: ISO$ <br /> Home Phone: 5O& q5-7 '235 1 Email Address: �Y�iW 2P�/il Cp A10 1 1✓1R! �'COo"f <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> I certify under the pt:nalties 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 law. <br /> 011-q0 - OF� 16 <br /> *Signature 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 /> NAIME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> **Your social security number will be fumished 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 Caumontvealth ofMnssaclutsetts <br /> BAIL\STABLE ss DATE <br /> Personally appeared before me the above-named mi6,Ul1' L- CL7'l) •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 su mess shall be conducted and shall lapse and be void unless so renewed. <br /> Signe <br /> I <br /> I <br /> &o a ubIic <br /> SEAL <br /> • orr��ecryp,% Ptress.. d <br /> OOIY "SALT HOF MASSAOMRIE <br />