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BUSINESS CERTIFICATE # Sa <br /> THE COMMON141EALTH OF MASSACHUSETTS <br /> TO HIN OF MASHPEE <br /> DATE 's — 1 9 - a° I t <br /> Expiration Date: 6-3 1- DO t 3 <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 unddei the title of la <br /> Business Name/DBA: 1 14M Oft -'he_ (70 Corporation Name: Nl� is conducted at <br /> Business Location: In RDPJ o,r Drl re ; YYl las eee. rn A <br /> Business Mailing Address: 'e l p&)w 2s2 p <br /> Business Type: �� f _( II�,Y 5E1'VI(� Business Telephone: 5OR -2-1-4 -0 VQ3 <br /> Home Phone: 53q- ( ru.. Q Email Address: 101 s O/1 Gi0 (� Q�� • �� <br /> by the following named persons: <br /> Owner Namecaner Residence <br /> ry)QJ rr.e !- acat�tr� 1� Iter Dr. . C71c�h�ee <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 /> �iature of authorized av "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: fj' Q.n-r-, S28ri,rl TELEPHONE NUMBER: 508E 23-7' CxnoQ <br /> Alarm Company: ti <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 susuension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> Tire Commonwealth of Massachusetts <br /> BA12N'STABLE ss ,/yam � Q DATE S' (9 —a° It <br /> Personally appeared before me the above-named t t t1Y e.,et,'�e''� Lctq cc" 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 /> SE zaz <br /> � Notary Public �1 -a a-a'0 t-) <br /> Margaret ClSantos Commission Expires: <br /> CommoiiiveaM of Ess uselts <br /> KNEt, mmisslon Ex Ires.on Sea 22,2017 <br />