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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE1 7 /'ILI <br /> DATE a <br /> Expiration Date: Z 9W <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 L <br /> ''''SS�� , ELI �rN <br /> Business Name/DBAt:-CAP Cr��� Q�'1aL.%*01ration Name:CAf�h.S eltLI�its conducted at <br /> Business Location: / 6AyNdV 66X 1)P//t��i uL" MAS rL Mft o�l(JTa <br /> Business Mailing Address: �ft-07& KTS 10 ha V4'-- <br /> Business Type:RLtAL EA91—h Business Telephone: <br /> Home Phone: ,moi D 367 `� �Z� Email Address: �nt�E' C&CI IXL}/10Y!X– <br /> by the following named persons: 4FfT6TF. com <br /> Own r Name Owner esidence <br /> _S ok n I� 6214N 6/h"I . <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 /> tax requ'red n r aw. <br /> IIWSiLure 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 /> /I / ,, .y1J, In case of emergency <br /> NAME: can Z Coh, 49 -'94Xe__- 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 Massachusetts <br /> BARNSTABLE ss �/�/� DA �TE —a7 � <br /> � <br /> Personally appeared before me the above-named I\ Nf and made oath that the foregoing statement <br /> is true. <br /> A certific t ied 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 yea 7 crege so longA such business shall be conducted and shall lapse and be void unless so renewed. <br /> Si <br /> Notary Public <br /> • <br /> SEALDebamh name <br /> . <br /> m NO 6' re <br /> Commtmwun of Musadmum <br /> 0MYC0MMft0EQftJWy29.2Dl6 <br />