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BUSINESS CERTIFICATE# �_� d <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: v0 [,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 declare(s)that a business under the title of <br /> Business Name1DBA:,4W,,7/14vr,_? p,r ✓.__s&_rporalion Name: is conducted at <br /> Business Location: Jul 32 <br /> Business Mailing Address: ✓ G/�� 7 <br /> Business Type: AN .- S e er.wr.. Business Telephone: <br /> Home Phone: I SD b k771-3 Email Address: <br /> by the following named persons: <br /> Owner Dame Owner Residency J <br /> //s <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 as re uir Sr law. <br /> ature 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 he subject to license suspension or revocation. This <br /> request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing statement <br /> is true. <br /> A certificate issued in accordance wiiP this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years thereaft Ong as such b1less shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Notary Public <br /> • SEAL <br /> ;yPlotary PublicauP <br /> Marg <br /> stet C:Sant0S Commission Ex vcs: <br /> t com nymatthoreMO Up%.sells 22,2011 <br /> commission Et Fx <br />