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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE /a?/ <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 a business under the title of- <br /> Business Name/DBA: CIt10/] l OU�/�JCorporation Name: / <br /> is conducted at Business Location: L� r /U�(t Cts/\ /� Commercial_Residential�/ <br /> I ,/ q� / �7 n <br /> Business Mailing Address: L /"�(fl7QtJA /CCS <br /> Business Type: Clem ZZ2 S Business Telephone: ��/) - ��g'9 (0 / <br /> ew Renewal i I Home Phone: SPQR J J /- /6 Email Address: <br /> by the following named persons: <br /> c � Owner N�tne L / Owner Resit{ence <br /> 6go =,lr—L0yVlanrh.2 !� M0nCAU) l< lel . <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 requ nder law. <br /> nature of torized 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: — L'� CJ[� TELEPHONE NUMBER: .S"n 8 X39 968/ <br /> Alarm Company: <br /> I <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met lax 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 as � DATE <br /> Personally appeared before me the above-named L CLYt Cott r-6-24PIL!'1(A/ and made oath that the foregoing statement is <br /> trot. <br /> A certificate issued in accordance with this sectio 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 Pub m <br /> SEAL o� OEbOfBh Qaflll <br /> NOTARYPUSUC Commission Expires: <br /> CommonweM of MusadWa is <br /> My Commission Exgres Jury 29,2016 <br />