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BUSINESS CERTIFICATE # I O_403 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> • Expiration Date: I el <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby decla <br /> ��re <br /> ,( <br /> (ss <br /> �) that a business under the title of <br /> Business Name/DBA: OQee <br /> E ; C c,(�X A,3 (�➢4M, V. Coi porattton Name: / <br /> is conducted a[Business Location: CLJ t;X V1A401ss-ef— zbjg�_ Commercial—Residential V <br /> Ic lC <br /> Business Mailing Address: <br /> Business Type:4�01-1 <br /> rte_ :g2asml/P� Business Telephone: <br /> New 1 1 Renewal 1✓T Home Phone: Email Address: 12Sk4A-J &76 y`f&ff- CZVY <br /> by the following named persons: <br /> Ownerrue,� ) Owner Residence <br /> �?n/9v.f r�l ffDV 621 "VOJ64(� t9lCge5F HN� <br /> I certify under the nal ies of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> t required der I w. <br /> colo(-��` (F—�3S J <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:&IA14 OaPA4 7 <br /> TELEPHONE - � _— <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 Common wealth of Massachusetts <br /> BARNSTABLE ss DATE / ?� <br /> Personally appeared before me the above-named C,A a-L,� and made oath that the foregoing statement is <br /> true. <br /> A certificate is ed in accordance with this section shall be in force and effect for four years from th of issue and shall be renewed <br /> each fourr therea r so Ion as such business shall be conducted and shall lapse and be void unless so r wed. <br /> • i <br /> Signed <br /> • <br /> NoTa Public <br /> SEAL JOSEP"L.U <br /> AM=MEW ini <br /> C01tM <br /> . MY Corrmtocion F�lres <br /> Orla0et25.7019 <br />