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ji> BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS a �, <br /> TOWN OF MASHPEE Y <br /> • DATE S ' )7 , ) 2– <br /> Expiration Date: <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 <br /> -a business under the title bf-' <br /> Business Name/DBA: `Q0.'O S Cor oration Name: <br /> Cd—(Q d SOQt-t-` C- 1 i"� e — .0 RLS <br /> is conducted at Business Location`! Commercial V Residential_ <br /> Business Mailing Address: <br /> Business Type: rQr"Abd C r Ar Business Telephone: <br /> oA —'y_'t_VA <br /> Newl\/] Renewal J I Home Phone:,SjOq y g 6 n 9 Email Address:- Casio r na (o3SP.Z°LY`"�al <br /> mom <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Ccr , Mk 0a � 3S <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 a equired under law. <br /> L4, oC(mqWa � <br /> nature 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 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 �Y�u.a,t —It 90i.A- <br /> Personally appeared before me the above-nameds(1cr�ln 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 /> jeach four ars thereafter so long as such business shall b ducted and shall lapse and be void unless so renewed. . <br /> Signe ���� r <br /> • : r_ Notary Public <br /> � "- Notary Public 9 - a a - a�t1 <br /> Margaret C.Santos Commission Expires: <br /> ®�- Commortweellh of Massachusetts <br /> My Commissbn Ex ices an Se t.22,2017 <br />