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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE Q <br /> DATE (, <br /> Expiration Date: h' A, / <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),tth/at a business under the title of <br /> Business Name/DBA: / p/C/rj - / / jy�Z/�Co�rpporation Name: is conducted at <br /> Business Location: To rN>/Ma.'s 'X 9y/.C& /t / // q <br /> Business Mailing Address: fa 0" 2V 0ll <br /> Business Type: Business Telephone: <br /> Home Phone: Email Address: /9eP�a><aSr� 04.v/�/�JT. Ar-71 <br /> by the following named persons: <br /> Olyper N me Owner Residence <br /> 1 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 /> —taxe/s�as re O under law. <br /> _Si nature of authorized dient "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 n2 <br /> NAME:,/fiy,S.J 1 ���r�fITT TELEPHONE NUMBER:��r Sa�' 7 Fld <br /> Alarm Company: W <br /> i <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 <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 we. <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 />