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Poo' '�-A <br /> BUSINESS CERTIFICATE <br /> .TOWN OF MASHPEE If <br /> • Date: <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: Tama ah Ft ZtIJIUC Business Name/DBA: 1�G yldl _O k co i Si A' <br /> is conducted at Business Location: 6<& \ �1yvlaytl � - ti1OLcil Ke1 MA - 0n2WiA <br /> Business Type: g-`eCi Q f � <br /> New ] Renewal [ ] -- Commercial [ J Residential [ ] Email Address: <br /> Business Mailing Address: kg L. N� A - 0'14 <br /> Business Telephone: SZ*- 'G4f'1 1 Home [ ] Cell [ ] Phone: ';D(b 7 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> �cL11aP0M < otn6(SCA I,1do16 102- )-i1cve- Drive'- <br /> 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 states as required under law. <br /> GxeaQa / 4-61q-7L-,F14 <br /> *Sig�urere 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 /> // <br /> NAME: �iA.M �a� oif� TELEPHONE NUMBER: - Y��GS7S� <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 Vq e <br /> BARNSTABLE, ss DATE �L <br /> Personally appeared before me the above-named !a'f� (34a)9 Ut 614Nand made oath that the foregoing <br /> statement is true. ppyy���p� <br /> A certificate issued in accordance with this section shall be in force Aibrl'our L' �the a e o issue and shall be <br /> •renewed each four ears thereafter so long as such business shall be conducted I M4f014 I ed. <br /> MY <br /> Signed o ublic <br /> Commission Expires <br />