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BUSINESS CERTIFICATE #_gam—Q <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 1 S o 1 <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: C�epCCj�P 1.-/IarIIt� S CorpoprationN�ame: CU�7 �t/G�'I ZS LCG is conducted at <br /> Business Location: iD re Hggl ee /`r7rn17W,( Mk* 0919 o26 yg <br /> i <br /> Business Mailing Address: :PO $0X 2y0Z Mafhlxt- 0914 02_6y9 <br /> j Business Type: t "(ttILe b eke t l Business Telephone: SI�rC- tI77- Z z 5 3 <br /> Home Phone: Email Address: fl?nn U LZSSCL0 GLO( .rA/YI <br /> by the following named persons: <br /> Owner NOw er Residen <br /> Rnnv ame licca Io Iyzr�Grna� e�?d . Porassef M;J ozss9 <br /> L aniel Lusa sAme <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 asr uired and aw. <br /> a6 -17i?o6c <br /> �gnature of an ized agent "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 <br /> NAME: TELEPHONE NUMBER: , OR-a7_y'59(/8 <br /> Alarm Company: n 1Q <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 Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE G/- /S -ZIG 1,2 <br /> Personally appeared before me the above-named �e't` h"1 P S S `l and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in a cordancc 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 t eager so Ion such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signedg <br /> Notary Public s+mary Public <br /> S Margaret-C.Santos <br /> • ®� Comttronwealth u1 Massed usetts 9 " a <br /> Cammstuon '1resonSept.22,2017 Commission Expires: <br />