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BUSINESS CERTIFICATE c � "Oy TOWN OF MASHPEE Date: $ 3o Z0l3 •, b o � Expiration Date: In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the undersigned hereby declare(s) that a business under the title of Corporation Name: DEl1 Z2/ 76,1 Business Name/DBA: is conducted at Business Location: Business Type: 4 //c4AJ New [ /Renewal [ j --Commercial [ ] Residential [ ] Email Address: Business Mailing Address: 3 S7: �7 t��/� ' AA . O-Z-:7-6 3 Business Telephone: 509'-523•-5.781 Home [ j Cell [rj"Phone: 570� by the following named persons: Owner Name Owner Residence I certify under the a pe that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all s es a ed , /6 ><: *Si ature of au orized agent **Social Security umber(Voluntary) • is license will not be issued unless this certification is signed by applicant or Federal Identification Number I In case of emergency NAME: TELEPHONE NUMBER: Alarm Company: "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. The Commonwealth nvealth of Massachusetts BARNSTABLE, ss DATE G 4 _9 Personally appeared before me the above-named PAL. - t � L� I and made oath that the foregoing statement is true. 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 renewedour years er after so I ng ch business shall be conducted and shall lapse and be nless so renewed. •Signed ,,� Notary Publi L mom" CommissioYAb! � ��ti1111p�