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;Y ( � TE # Cl G <br /> BUSINESS CERTIFICA <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 05_0q• 1201/ , <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: t ?e L! Corporation Name: is conducted at <br /> Business Location: C'9 /qI7»Q/I✓) 5 /1� f�SHpC-L 0 <br /> 24 <br /> ' '19 <br /> Business Mailing Address: °� —t ► rma/'>7 ST M 19SH PL-r <br /> Business Type: rI e J+Al Business Telephone: <br /> '9 si. tis <br /> Home Phone: Email Address: M w K t NE t iq G. a vt,o <br /> by the following named persons: <br /> Owner Name Owner 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 /> 01 '7 9'3- 5-7 e 9 <br /> •iature of authorized 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: <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 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 /> BAIL\STABLE ss DATE <br /> ,�I^ <br /> Personally appeared before me the above-named Mot.`O/• h at. G u e r rL• 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 �01 ►t,, ._ .. .�. / `, <br /> • olary Public <br /> Notary Public <br /> Margaret C.Santos QI a a 20 I <br /> comuniveeltlt of Massachusisft Commission Expires: <br /> CommUilin Ex inis on Sept.22,2017 <br />