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Fj <br /> BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE <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 �C <br /> Corporation Name: Business Name/DBA: `G <br /> � 157�/7� ' 1fe-Ty <br /> is conducted at Business Location: 7� �i V�kV����✓� G `C✓�5����� <br /> Business Type: 4 "4zo�71e- �Ie5 //� <br /> New [Renewal [ ] --Commercial [ ] Residential [ ] Email Address: �Uh7�/4✓ "ZZ � fAAJ 'G�7 <br /> Business Mailing Address: �q0' °X <br /> Business Telephone: �9' S 3/ �� Home �Cell [ ] Phone: S0� 737 /�� <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> I certir the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all s xes a /� ��under aw. <br /> O '�o <br /> *Signature of authofized 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: Gl16/(y�- G�yJy�� ,U4�e��d TELEPHONE NUMBER: 77 <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 subiect to license suspension or <br /> revocation. This request is made under the authority of Massachusetts General Law, Chapter 62C, Section 49A. <br /> Tire Commonwealth of Massachusetts <br /> BARNSTABLE, ss DATE <br /> Personally appeared before me the above-named /t76,t/ Ant"'+"' and made oath that the foregoing <br /> statement is[rue. <br /> A certiSjrae issued in ace�r�an�e with this section all be in f c and f ur ars from the date of ue and shall be <br /> renewed eat years th ey�e'fong as business a condi <br /> PI�nd b void unless so rene e . <br /> 1(� Ni PUBLIC <br /> Signed ✓h -fr�01N11011 '01 <br /> / WCanlltllsslofrEon 29.2016 <br /> Commission Exoires <br />