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i BUSINESS CERTIFICATE# ad)PL"6 3--C <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE 2-112— <br /> • DATE <br /> Expiration Date: 31 <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declares) that a business <br /> under the title of <br /> Business Name/DBA: Corporation Name: <br /> is conducted at Business Location: �/q r S Commercial ✓ Residential_ <br /> Business Mailing Ad//dress: / <br /> Business Type:OeG+7�/� oiJ�6th"t- �j Business Telephone: /6 /� <br /> New Renewal Home Phone: �d0 ' .7✓7/'��`�S Email Address: 11M)AMLS /114(9�ej P>C.,,W <br /> by the following named persons: <br /> Owner Na e, � Owner Re idence <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 'equired under law. <br /> foo --zs / <br /> _ toe of autT&6ed 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 fumished 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 47A <br /> 1 7� <br /> Personally appeared before me the above-named S �heN °"�+l��'f 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 62 <br /> UUU `V <br /> LLU <br /> Notary l31LYo , <br /> • JR <br /> SEAL COWIONWEAITtI OF MASlACMU <br /> Commto <br />