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i r- <br /> BUSINESS CERTIFICATE# (12 O <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE <br /> Expiration Date: ti 2-0 <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) <br /> that a business under the title of <br /> Business Name/DBA: �Cc Corporation Name: is conducted at <br /> Business Location: � M.oe me (.`10n?J <br /> Business Mailing Address: o 1 '�^y�%pte LbSsDee- MA 624'(lBusiness Type: Business Telephone: 0-19) 77La- 5 ttt <br /> aL <br /> Home Phone: J - Email Address:r� t1t-�� (t,1��t,]or :na� 'ylv� <br /> by the following named persons: <br /> IF,N e 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 /> taxes as required under law. <br /> ature of authorize 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 famished 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 of Massachusetts <br /> BARNSTABLE ss DATE o Ukk <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 �Qr S _ , <br /> Notary Public <br /> • SEAL <br /> � VI[:KIO <br /> Wro <br /> Comnossio9 des: <br /> MMONWEALTH OF My Cain Eq*u <br />