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BUSINESS CERTIFICAT I3�- ✓ _ <br /> .TOWN OF MASHPEE <br /> Date: IS 14 <br /> Expiration Date: <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: Business Name/DBA:A Yng l-r 1DePtEwry-" <br /> is conducted at Business Location: 3 N 6851LP P i W 11 Qc-z 6& 6,a GL) <br /> Business Type: <br /> New Renewal [ ] -- Commercial [ ) Residential [ ' Email Address: <br /> Business Mailing Address: dal N6WQPSH V2:E t Nv/A uaLtl q <br /> Business Telephone: KGS- '11-7- 31179 Home [/] Cell [ ] Phone: 505-- W? - 3179 <br /> I <br /> by the following named persons: <br /> Owner Name Owner,Residence <br /> �A`"'<;S S �raa2��� �� n�vAttclk Rpt v� us Noy-� , v«Aoa�vs <br /> I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all state taxes asrequiredunder law. <br /> �cryot frr{,� Ua t • 3�-4'Q B 7 <br /> *Signa re o 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: SAN°'nR giNVrw� TELEPHONE NUMBER: K05- T-73-412l13'> <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 /> e revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C, Section 49A. <br /> The Commonoveahh of Massachusetts <br /> BARNSTABLE, ss DATE 14- <br /> Personally appeared before me the above-name wtr and made oath that the foregoing <br /> statement is true. <br /> A certificate issued in accordance with this sectio shall be in force and effect for glKh-c@fb'-dfJGbe <br /> Orenewed eachour yea thereafter so long as such business shall be conducted and shall laps �tMrbess 319ti'atif dd. <br /> Si ned Notary Public My Commission EKones <br /> ETT9 <br /> g —�T Cobert <br /> Commission Expires <br />