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BUSINESS CERTIFICATE#12Zr <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> `t TOWN OF MASHPEE <br /> • DATE tC. 3 � I <br /> Expiration Date: 3 a-/ 'J <br /> i <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: Pal h LCO aPc) �Ri 15 Corporation Name: is conducted at <br /> Business Location: c; ('o nkP f YPPJ77 M a 51 t NTPP. <br /> I ' <br /> Business Mailing Address: l Vn� <br /> Business Type: S01�Dt1 e) Business Telephone: <br /> Home Phone: 70A -SI —sq Email Address: ie5_ i Ca 115. <br /> C-em <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> e s5 <<t , c . AnQ.h�P--- s <br /> 5"),JLL)I - AAft DZS5� <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 /> lWatu—re6A 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 /> "C //� In case of emergency G <br /> NAME: I J w 1 U �v I a I Py— 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 <br /> request is made under the authority of Massachusetts General Law,Chapter 62C, Section 49A. <br /> The Commonwealth of Mass �huspeass <br /> BARNSTABLE ss s � PJ`� 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 hall 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 /> • SEAL H L.MAZZUCCHELLI,JA <br /> Notary lbic <br /> omrm 'e8 <br /> QGtaber 25,2D13 <br />