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BUSINESS CERTIFICATE 4 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> • Expiration Date: 3 <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� <br /> Business Name/DBA: 149 1. OWtlLtb�l'uCu-�7�OY� (�nI�rporation Name: <br /> is conducted at Business Location: �?:q kowe 1 f 6.1 Commercial_Residential_ <br /> �6.,,•Ctbk�2.e- M.A• oa6YY <br /> Business Mailing Address: SGu�,'+�clo l oG1.bi U'�•� 4 — <br /> Business Type: Su(Ho' Vl Business Telephone: (Q 7/ - 5 7_1 - I -- <br /> New Renewal Home Phone: SCNke- wo h'"'� Email Address: U ���Q " Sa' a✓ A� y�(-O.O-CM <br /> by the following named persons: <br /> Oner Name Owner Residence <br /> lorr1 w'�o nom- _( �•f i-owe-11 <br /> S it �1" 45th `e9 <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 /> ,"'Nes as requiredu der layn <br /> na re 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 ojMassachusetts <br /> BARNSTABLE ss DATE��' <br /> Personally appeared before me the above-named rI5 v= V J e� ✓ SU Cox,trs 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 <br /> Notary Public <br /> SEAL <br /> Jowwwamm_ <br /> OP tIM88ACWi <br /> Canminbn6pYr <br /> Qblir T� <br />