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BUSINESS CERTIFICATE# 73 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE � A U <br /> Expiration Date: CO -M J� <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 NamODBA: orporn p➢ame: is conducted at <br /> Business Location: �O 71 //�oma _ il4 I /1 cBjp <br /> Business Mailing Address: � _739L <br /> 7th /, oa�Oyq <br /> Business Type: � <br /> [/ a Business e one: / 7� �JnS— 7 Z(e Z <br /> Home Phone: I cS Email Address: / �1/�O( (G"LGj✓Jr1�J� p (f�( <br /> by the following named persons: <br /> Ovytut�r Namg / / Owner ResidZrJ <br /> ence <br /> 96 <br /> I certify 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 /> taxes as required under law. <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 <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 he 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 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 />