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BUSINESS CERTIFICATE # <br /> THE COMMONI'VEALTHOFMASSA CHUSF_TTS <br /> TOWN OF MASFIPEF <br /> DATE ) <br /> Expiration Date: <br /> I <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby cleclare(s) that a business under the title of /� \ <br /> Business Name/DBA: I,J�oe�e.SS l=l. Corporation Name: 1-F �C^T ��-�7 .\ is conducted at <br /> Business Location: ��e I, '{77 /���5� RQP nI/I�t t���� <br /> Business 'MailingAddress: \�ot' \he\� Yy t c�S� t t 1 t o Oo\-&9-\A <br /> Business Type: ujz ce,�� ��� -.T_UC C_ Business Telephone: <br /> Home Phone: Entail Address: J6 GJc�� FS C t7 itY e55 C y �d/Y� <br /> by the following named persons: 1 w �� ,,�1�l <br /> �wner S 310 \Owner Residence <br /> htll.� <"'Y iilf IJ-T�_t 11 4 Q�Iny"t <br /> W� 1 <br /> I c ify er the penalt s -perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> ta. as t red under v <br /> nature of authorized agent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signet) by applicant <br /> In case of emergency <br /> �- <br /> NAME: a f -5".0 �OS� TELEPHONENUMBER:3-SCI-c�O�-OS� <br /> Alarm Company: C) D7 .\0_� <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 wider the authority of iblassachuseus General Law,Chapter 62C, Section 49A. <br /> The Commonwealth of-Massachuselts <br /> BAR.NSTABLE ss DATE <br /> Personally appeared before me the above-named 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 /> SEAL <br /> Commission Expires: <br />