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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <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 amended, the <br /> undersigned hereby declare(s)that a business under the title of A <br /> Business Name/DBA:SOICLrnerCJ1aRf, Corporation Name:A U4s1, of S t1�/Qr� � is conducted at <br /> Business Location: <br /> MAShere- cAy i&As 12- Cehn+04 S <br /> _ n �Y N�'IOPIL �YvM)Ld'I\ <br /> Business Mailing'' '' <br /> Address: nn �•0 • CbX (yIV I (0LL�� MA 02- 641 <br /> Business Type: r� Business Telephone: 14t-7,4 '6`�•tQ_'Z�—� �� , <br /> Home Phone: LI7•L{S5. 6172_q Email Address: �D1CaJllf�t lllsCd[Dt�CtXTLiAIQt f <br /> by the following named persons: <br /> Owner Name Owneresiden � 3 1 <br /> U--,A YVt Cgod✓1QUqh �c.Savr�ux(�-t <br /> W414Y 6, S. W4-XkQ.tr 2 �,,;LT PLti L 5avdwt.4%n <br /> I certify under the penalties of perjuVihatll, 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 /> 4j <br /> �lc� - 253z3z5 <br /> a j <br /> of autArized 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 /> ' 1 �` 1 , In case of emergency <br /> NAME: l>,1A lnv�e S. WA1ICII4r TELEPHONE NUMBER: ��� 2t J•3 �S <br /> Alarm Company: Nj pt <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have mel lax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will he subject to license suspension or revocation. This <br /> request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE U D613 <br /> Personally appeared before me the above-named w S fa \ C>Vea Kka and made oath that the foregoing statement <br /> is true. <br /> A certificate issued in accordan a his section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each fou ye thereafter so long as suc bu ' ss shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> 1 1 IL.M�I 4Aj <br /> • Yotary Public <br /> SE <br /> Notary PubliC 9 <br /> Margaret C.Santos Commission Expires: <br /> Commomvoslth of Massachusetts <br /> M pommisslon Ex Tres on Ss .71 zp17 <br /> i <br />