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l BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE Z <br /> • Expiation Date: 3V .24/ <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((ss)�that a business under the title of <br /> Business Name/DBA: /�!4<4 0 ar7lA)I f Corporation Name: <br /> is conducted at Business Location: C�ommercial_Residential_C <br /> Business Mailing Address: /tom oK r' g S m4 Si OGL J�1A 24 Y 7 <br /> Business Type: //'i'OM P/N �(jNIJY g5_Business Telephone: <br /> New IPY Renewal I I Home Phone: 509' y77 X570 Email Address: 7&0q4 oft QS " <br /> by the following named persons: lk"t Gory <br /> Owner Name Owner Residence <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 req d der <br /> O�`tt:Z YZ � <br /> na re 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: U eo rfL Wen TELEPHONE NUMBER: $, y 7715 ! s y <br /> Alarm Company: <br /> �t <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 �� ,� /{ A- DATE 'L <br /> Personally appeared before me the above-named (J"r`-��� N C 'G1/ and made oath that the foregoing statement is <br /> true. <br /> A cer icat e issued in actor c 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 1. atter so Ionvuc�usiness shall be conducted and shall lapse and be void unless so renew <br /> Signed <br /> Notary Public <br /> • SEAL Ak JOSEPH L.MAZWOCHI <br /> CommisLI s: <br /> COMMONWEALTH OF 9ACMI6 <br /> MyCownbsionEViin <br /> 0 01*15;2013 <br />