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.y <br /> BUSINESS CERTIFICATE# �`=a <br /> THE C OMMONWEAL TH OF MASSA CHUSETTS P9/ <br /> TOWN OF MASHPEE <br /> • DATE 3 (Y <br /> Expiration Date: 3 �I a-d <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: 1N1 a h >r / V t/I 10-4 IL Corporation Name: <br /> is conducted at Business Location: Commercial_Residential�� <br /> Business Mailing IA^ddJ�ress: � ® 1kS BOC 1 633 /` <br /> Business Type: "V t/\ SIYI V `/ Business Telephone:<6r4 �/ <br /> Business Phone_<D� 9�I- I (9� Home Phone: Email Address:/'nS'Ct d e o vv-/ I✓�s/G�r"�'�✓ <br /> by the following named persons: <br /> 00wner Na Owner Reside e <br /> tnK'U f -, kA <br /> l�if P ✓ 1 U f �t C <br /> L� <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 required under law. <br /> ol .q Sy _ a a .Ky <br /> . ature o at}Ft ori age "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 orlax <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 BARNSTABLE ss DATE � 17' ZQtZi <br /> Personally appeared before me the above-named ku 5jfg89 Wr 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 /> • - N to P bli <br /> AL i� .r3SEPH L.b1A .Ll, <br /> COYYDtlWEALgES�BAJI9l�NYF . <br /> Vy Conwaslon E1(Qi10! <br /> 0lloDer�If,7t113, <br />