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r ' BUSINESS CERTIFICATE )/3/3 _D3S <br /> TOWN OF MASHPEE !I <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 <br /> amended, the undersigned hereby declare(s) that a business under the title of <br /> Corporation Name: IhL 11 I�,) LA., BuusinessyName/DBA: <br /> is conducted at Business lPLocationi�:l I�Il !i Man an S 1 �1 �� Ma Apeej mn b2l 44 <br /> Business Type: I I� a) flub <br /> New [ ] Renewal Commercial J Residential [ ] Email Address: 67OW/I• 69122 <br /> Business Mailing Address: qq <br /> Business Telephone: Home [ ] Cell 1P Phone: TLI "0 741 Z <br /> by the following named persons: I` <br /> I <br /> Owner Name Owner Residence <br /> Y�1er�di�h No r �IP� NDb K\ if, Dr <br /> SQh(�il11Ch Mh 025 3 <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 <br />• all state taxes as required trader law. <br /> 1/4% <br /> *Signature of authorized agent **Social Security Number(Voluntary) <br /> *This license will not be issued unless this certification is signed by applicant or Federal Identification Number <br /> In case of emergency <br /> I <br /> NAME: �t TELEPHONE NUMBER: <br /> Alarm Company: CL[pC CDA h1of1Y1 <br /> **Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax <br />� filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or <br /> revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE, ss ! L DATE <br /> Personally appeared before me the above-named MCY-U/t 1 N/ 6019 and made oath that the foregoing <br /> statement is 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 <br /> renewed each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Figned /!/ Notary Public <br /> Commission Expires <br />