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1, rt <br /> BUSINESS CERTIFICATE <br /> TOWN.OF MASHPEE <br /> Date: 07 a?o/3 <br /> Expiration Date: 3� <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: score OLr <br /> is conducted at Business Location: ✓� �.P��/ro1/LC` /��� Ty <br /> Business Type: <br /> New [✓] Renewal [ ] - Commercial [V1 Residential [ ] Email Address: <br /> Business Mailing Address: A� Aovk OUSY&W E /V-4 49W"o <br /> Business Telephone: of v o �799 5 Home [ ] Cell [ Phone: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> a.H 46Fivva)" <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 as required under law. <br /> P79'�6 -s egg <br /> *Signatur of thoriz agent. **Social Security Number (Voluntary) <br /> *This licens ill not be issued unless this certification is signed by applicant or Federal Identification Number <br /> In case of emergency �v � <br /> NAME: ( FA!AAo D-�re�lL 1�0 TELEPHONE NUMBER:%�O Opo 7A/ 79 <br /> Alarm Company: <br /> 9 <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 Commomvealth of Massachusetts <br /> BARNSTABLE, ss / ,^ py��� /� DATE . , Z.O <br /> 8 Personally appeared before me the above-namedFLG(��'I91 q CO �I/K�/��a d made oath that the foregoing <br /> statement is true. <br /> A certificate issued in accordance with this section shall be in f re nd effect for four ys from the date of issue and shall be <br /> renewed each four years the er so long as such kiUaess shalall lapse and b oid unless so rene e <br /> ° NOTARY Pt <br /> Signed I;�IIIIgoMRm of tic <br /> W Comnds slim Egii JWY 29,20'5 <br /> Commission Exoires <br />