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r <br /> BUSINESS CERTIFICATE# <br /> / <br /> THE COMMONWEALTH <br /> OF MASSACHUSETTS y <br /> TOWN OF MASHPEE I <br /> DATE 4— 10-13 <br /> Expiration Date: 7 Isd 0 <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) thatt�a bu1sineess under the title of/�',,l �/� <br /> BusinessName/DBA: I fo(� 1 t'XFlgr7(y��f�C�(`a�l,YltntCo iorationName: <br /> is conducted at Business Location: at 'YI,t.L'�K L6.c/IP ��J Commercial_Residential—Z <br /> Business Mailing Address: Ke i' Lan P <br /> Business Type: Business Telephone: <br /> New \ Renewal Home one: Email Address: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> �u ga mw'I KetC ne 0145/,,pee 111<4 <br /> I cert under the penalties of perjury that 1, 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 /> *Signature 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 C �j � <br /> NAME: � TELEPHONE NUMBER: 0a I '`SL(/ <br /> Alarm Company: <br /> **Your social security number will be furnished to the 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 subject to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C, Section 49A. <br /> The Con turonwealrh ofMnssuclutsens <br /> BAI2NSTABLE ss DATE t.3 <br /> Personally appeared before me the above-name<�O P Du z1 R cert and made oath that the foregoing statement is <br /> 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 years t reaRer so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> N Lary Public <br /> JWAL Notary Public <br /> Margaret C.Santos ate—�O11 <br /> • Commonweab of Mmachusetts Commission Expires: <br /> My Commission Expires on Sept.22,2017 <br />