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I' BUSUWSS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> t <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((ss)that a business under the title of <br /> Business NameMBA: No K%h �1 <br /> 1S l �p_� n Corporation Name: is conducted at <br /> Business Location: IO G <br /> 1 <br /> Business Mailing Address: <br /> �► 1� Psi t <br /> oa�o�q <br /> Business Type t h�ICFT � �-7I '� Business Telephone: •� <br /> Home Phone: 53� 3 1 Email Address: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> e- 1 "ct-ap LA <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 /> a <br /> Signature of authorized 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 /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> "Your social security number will be famished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subiect 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 BARNSTABLE ss �� DATE�� <br /> Personally appeared before me the above-named r"1fC'Q-�L� and made oath that the foregoing statement <br /> is we. <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 ars thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> f' <br /> Notary Public <br /> SEAL <br /> St0¢'�La!07R1p <br /> "l t rd ro�iitto0 <br /> *"w&WON <br /> 1. 1 Hd3SGP` <br />