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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWA'OF MASHPEE <br /> • DATE 14111 <br /> Expiration Date: <br /> In conformity with the provisions of Chaptcr one hundred and ten, Section five of the,General Laws, as amended, the <br /> undersigned hereby.declaayr��e((s)�that a business under the title of <br /> Business Name/DBA: WCorporation Name: is conducted at <br /> Business Location: M WN <br /> Business Mailing Address: .� <br /> Business Type: n M.�\��" Business Telephones�:\\ (� ` rl <br /> Home Phone: 5ps ` 1 5 ( Email Address: 1�i .�f ���\ r \ `{ �"-� \`� lyy\ \ •�v <br /> by the following named persons: <br /> Owns N'arne 2 caner Residence <br /> I certify under the penalties of perjury that 1, 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 /> Signature of authorized agent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *'Phis license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <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 subiecl 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 /> BARN'STABLE ss DATE <br /> Personally appeared before me the above-named and made oath that the fortgoing statement <br /> is 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 />