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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE / <br /> DATE <br /> Expiratio ate: ae)15 <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 /> 1 Business Name/DBA:,. Corporation Name: 144 is conducted at <br /> Business Location: a2, /1K/M/�-�1/1�/����E�Gy/�`1�1 �d�T'// ��G� t�//�� '?- ""— <br /> Business Mailing Address: 17 `Ldf p//f7 /yQ-Vl/'"L, A 42-0 f9 <br /> Business Type: KkJAI�/4' /�'LES�ry,.✓/� Business Telephone: j�,.�I <br /> Home Phone: ,l l�IT' /TSU Email Address: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> �fAtl nl a'P.aN^(o/L� �7Fi MkPif- . Kms' <br /> Icc tify 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 /> taL s as required under w. <br /> D' <br /> Signature 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 Q <br /> NAME: / lilpry' TELEPHONE NUMBER:�JuQ-�/7'7 <br /> Alarm Company: mi� 0d1A( <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 suhiect 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 94 ACb W hN U fkrtd made oath that the foregoing statement <br /> is 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 year thereafter so long as such busi s shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Notary Public <br /> • SEAL <br /> �, JOS61T, ks eLU <br /> e No"Rise <br /> COMMONvaFxrn or tus3+taastm <br /> tib camdsyon Emmet <br /> OMM25,21113 <br />