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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS .� I <br /> TOWN OF MASHPEE <br /> DATE to a3 � <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 Name/DBA:4.,-r aoic o Corporation Name: rKGVt4J77A/1 rte{2L is conducted at <br /> n �l Col,1 <br /> Business Location: X�j2_irns�/fh fCd �U� !Z <br /> Business Mailing Address: <br /> � JAG-H✓� q C4 <br /> Business Type:1v11j6'd �l/(�iiAtC�-�' '�TT.f�L Business Telephone: ��_-M_ ( 4 0 <br /> Sp-lelj /� � <br /> Home Phone: !W77 �9-/)�55� Email Address: L-/�'G>,(�gn �' os <br /> by the following named persons: <br /> Owne•Name Owner Residence <br /> /n,6 //FLC��yI A7 l s� �I/2. ^A) /YID <br /> �4r,A to— <br /> I certify under the penalties of per that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> [axes as fired under law. <br /> a authorikg 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 a 7 <br /> NAME: ,/g6a_,P r �oc C uzz i TELEPHONE NUMBER:-TO S- L/77-,6 / <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 <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 <br /> Notary Public <br /> • SEAL <br /> Commission Expires: <br />