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BUSINESS CERTIFICATE# / o <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TO PVN 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 declare(s)that a business under the title of <br /> Business Name/DBA: !!3�� aq�1 _Corporation Name: C. l>• 1 ( (V is conducted at <br /> Business Location:; © <br /> Business YfaingAdrVs: j" 3 Prju) yI�C�CZTr—�y---, �Mn 09 <br /> /44 <br /> 5-2 p� <br /> Business Type: Business Telephone:, <br /> Home Phone: 49�AL9%acip, Email Addressf�'. �S <br /> by the following named persons: <br /> Ow er Na a Owner Residence <br /> I certify under the penalties of pe ' uy that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> jesa required tinder law. <br /> aure of authorize agent "Social Security Number(Voluntary) <br /> 0or <br /> Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME:C.)M A- Q S w s r TELEPHONrE NUMBER:.- 3� An 7(O(7 <br /> Alarm Company:1)1)(\ Bt!'I <br /> "Your social security number will be famished 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 Commonwealth ajfl1assnchusetts <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 thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Notary Public <br /> SEAL <br /> • - Commission Expires: <br />