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BUSINESS CERTIFICATE-3-11 0/f <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> • Expiration Date: d l <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(s) that a business under the title of <br /> CAPE Ct>O cJRoat6HT <br /> Business Name/DBA: f A09 t�J02/S$ Corporation Name: is conducted at <br /> Business Location: 51 Qat AS,N r 4 C ROAD <br /> OAD <br /> Business Mailing Address: 31 0utA9Hr4ET Ron <br /> Business Type: 6ENERAL 1;)GL01 f-J Business Telephone: <br /> Home Phone: S0a - y 7 7 ro S06 Email Address: <br /> by the following named persons: <br /> Owner NameAq Owner Residence /� <br /> CHHEL E p"/,2777 31 (� t_,>as14 J6T /<O}j1) I�Sf/PGF <br /> U)&140 Ivli 2 TO <br /> {'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 /> ,r277_� 0q2 - 'i; Z g l y 6 <br /> JWature 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 furnishedtothe 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 /> I The Commonwealth of Massachusetts <br /> BiARNSTABLE ss / 1 7 DATE <br /> Personal) appeared before me the above-named O CtIQ / �A/lL0 and made oath that the foregoing statement <br /> s'true. <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 yearsJhcreafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed !/ <br /> • tary Public <br /> RFAI <br /> Notary P~'~`ubf c <br /> argaret C.Santos Commission Expires: <br /> Coonweft of Massachusetts <br /> h9myComission Expireson Sept.22,2017 <br />