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BUSINESS CERTIFICATE# <br /> i <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE �g <br /> DATE <br /> • Expiration Dates q <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 A'ame/DBA: - < �r ' ,, tt orplor�ati t ame: �^ �/ is conducted at q <br /> Business Location: 306 0 'KQM �A�.�. C'C!4= Z�' ' ' / <br /> Business Mailing Address: C_-t�_Y� e ,! <br /> Business Type:A_� tD usiness Telephone: -7 -7 L—a Z3 —1 7�� <br /> Home Phone: Entail Address: <br /> by the following named persons: <br /> Oavner NTSC -2Owner Residence � n <br /> c�(.r-�, (` � � Cf� ►l� �-vim Vt.Q-r ��Y <br /> Le ---m C'J } el 0-y� <br /> I certftaut <br /> ties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxesaw. CoZ 3 <br /> *Sign - **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 I U <br /> NAME: ((hVQ,= N�"_e ( A4_) TELEPHONE NUMBER:5t5 <br /> Alarm Company: <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 G?C,Section 49A. <br /> The Commonwealth of Massachusetts ,I <br /> BARt\'STABLE ss DATE o�� (/ <br /> Personally ed before me the above-named and made oath that the foregoing statement is <br /> true. <br /> A cc ficate is ed in accordance with this sect on shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four year there so Ion usine a conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> NotaryPublic <br /> SEAL <br /> JOSEPH L mAzWOCKEIM.JR <br /> * Comm?ftWV1FM' res: <br /> W <br /> OF {My <br />