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BUSINESS CERTIFICATE # <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TONIN OF MASHPEE <br /> DATE <br /> Expiration Date: <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 N'ante/DBA: (� -_ff Corporation Name: K/dS &t6{17/G �O/'�-G/� is conducted at <br /> Business:Location: Z 59 Roel Lmdm Rd 4108 /,lr�4Pee , IM �Z�z <br /> Business Mailing Address: <br /> 1 �� Fmercf�'ee=may <br /> Business Type: iL M / J / Business Business Telephone:� SG�.-f— SL/+S S-�•S� <br /> Home Phone: (;_6VV 35-9 S2 Z S M /Email Address: /' te6 c� l D 45rl • 4 Le-Z <br /> by the following named persons: <br /> �� Oar Name <br /> Owner Residence <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 /> taxesas 'e 'red nd law. <br /> nature of aittliorized 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 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 ofMrtssachnset(.c <br /> BARNS'PABLE ss DATE 5-"31- Goll <br /> Personally appeared before me the above-named '(mor\L e e} 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 f om the date of issue and shall be renewed <br /> each four years <br /> (hereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> y( <br /> �• otary Publicr <br /> SEA naryu I <br /> Margaret C. Santos � - �a <br /> Cor =mveaRh of Masse husetts Commission Expires: <br /> MY Cominission Expires on Sept.22,2017 <br /> 1 <br />