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i <br /> ' BUSINESS CERTIFICATE c241 "0 43 <br /> TOWN OF MASHPEE <br /> Date: 0 /3 <br /> • <br /> Expiration Date: 4 3v <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as <br /> amended, the undersigned hereby declares) that a business under the title of C <br /> lJ— <br /> Corporation Name: Business Name/DBA: CWS t_ Lmtagr new ftbcwu�a su Cb h9 \6�F <br /> is conducted at Business Location: 4`-\ grrc tlQ or't e'iwf ;L- LSA I'~ <br /> Business Type:ScQ.Qtct NA-"aa4NEN7 <br /> New [d Renewal [ ] --Commercial [ ] Residential [ ] Email Address: <br /> Business Mailing Address:, Sc-r.\I- <br /> -Business Telephone: _ oQ%- ag<_ Home [ ] Cell Phone: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> 14 Ct4'-ZX �oO x Wz- V-lA4AP44 MA 0`201 <br />� �•�nb \)P GR44 nJ s0.Mi <br /> IMF <br /> I certify under the penalties of pequry that I, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all state taxes as required under law. <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 /> NAME: TELEPHONE NUMBER: <br /> i <br /> Alarm Company: <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 /. //3BARNSTABLE, ss DATE Y <br /> Personally appeared before me the above-named tj A—f At 4-L-0 Arta 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 /> enewed each four years thereafter so long as such business shall be conducted and shall lapse and be void h les-sso renewed. <br /> igned� il�.� Notary Public <br /> Commissi E'rf`'A—M�-S <br /> ICOMYONWEALLTTH OF nExpirdNJt4T <br /> MyCanirnsionExpiras <br /> Ocloba'n,201J <br />