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1r ., <br /> BUSINESS CERTIFICATE# <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declaa (s)that a business der the tide of <br /> 012 <br /> c� <br /> �$ !%S<� `"• DBA t/ / L / 4 is conducted at <br /> S�//�G <br /> Business Locntion: ' I/a/// �` cL/ <br /> Business Mailing Address: <br /> Business Type: rBusiness Telephone: <br /> Home Phone: <br /> , y7_7Ys71 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> {-- <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 wired under law. <br /> *Signature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) , <br /> or Federal Identification Number <br /> NAME: <br /> In case of emergency <br /> jtrr!q TELEPHONE NUMBER: <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 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 Coaunontcealrh of Massachusetts <br /> BARNSTABLE ss DATE <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 shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years there tier so long is <br /> Signed i s shall Zted and shall lapse and be void unless so renewed. <br /> /fr/_� <br /> • Notary Public <br /> SEAL <br /> Commission Expires: <br />