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J <br /> BUSINESS CERTIFICATE# Q/— C�f fi <br /> THE COMMONJ41EALTH OF MASSACHUSETTS ` <br /> TO N/A'OF MASHPEE / <br /> DATE <br /> • Expiration Date: Z d <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 Namc/DBA: vj /l orporation Namr�6//H '" -,7 4. zq"'IQN.�'J}fKmAe <br /> QJ�tucted a(IF <br /> Business-Location: �� / �/.�noGJ� ��40/_ I !/`"LsS4 <br /> Business Mailing Address: J� <br /> Business Type: �Jy�T /��// /�� Business Telephone: //) 0 /�, <br /> Home Phone:^ _50174 ^L Email Address:�l /IG /^—�''Q •t+ <br /> by the following named persons: <br /> Owner Name / Owner Residence <br /> I certify under the penalties of perjury that o the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> i <br /> xes as re oder law. <br /> / �I/7 ;fid ori ykd 3 <br /> t� a authoriz 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 /> j 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 lax 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 Massachusetts13A.RNSTAI3LE ss DATE /l <br /> el- <br /> Personally appeared before me the above-named �'�'`.� H'W'r all, 4/t and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with thi a on shall be in force and effect for four years from the dale of issue and shall be renewed <br /> each four years thereafter g as suc busi e e conducted and shall lapse and be void unless so rene% <br /> Signed <br /> 0JS_L10W1rYq#2ffj0CN=j1 <br /> • SEAL .1 Notety PEI* . <br /> . y4r, Copy�oes6tbj�' <br /> pgo0er2S,'2017 <br />