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t BUSINESS CERTIFICATE# ;L_& 11--0 3 y <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE 7 ( f <br /> Expiration Date: Z <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 /> �u' r2&vtc a �v t„r +.�. <br /> BusinessName/DBA: (50A.S+S 'I.ttoA/ CorporationName: COL-9—ftT 4o^ r?V is conducted at <br /> Business Location: 61Z)7 / 4t0J"a'4 Sr ��Qy IY,4- U 64 �S <br /> Business Mailing Address: <br /> Business Type: F) h Act ta{ Business Telephone: S4 owl �/ 0196 <br /> Home Phone: Email Address: <br /> by the following named persons: <br /> Owner Name Owner 171en6 <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 quired under la rn� 7 <br /> ^ (� I, <br /> �oL7 (�7 <br /> nature of authorized gent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> 'This license will not be issued unless this certification is signed by applicant <br /> 71_ ,,//x In case of emergency �i <br /> NAME: -doe DQ [ ( Lie 11.4 TELEPHONE NU � S <br /> MBER:Sd6 U AT Y' <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 subiect to license suspension or revocation. This <br /> request is made under the authority of Massachusetts General Law,Chapter 62C, Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss A� ,1,� DATE <br /> Personally appeared before me the above-named• CAU tr/z r1<�Land made oath that the foregoing statement <br /> is we. <br /> A certificate issued in actor ce wtn shall be in for d effect for four years from the date of issue and shall be renewed <br /> each four years thereafter so long as 11 ch business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • Notary Public <br /> SEAL <br /> IMM <br /> Coiyprg xptres: <br /> COtm0NkMT11 OF <br /> Id f Ccumuatlon EW' <br /> @019- <br />