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BUSINESS CERTIFICATE '2-6 /3 <br /> TOWN OF MASHPEE <br /> • Date: <br /> Expiration Date: 3V <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: L� BussineeJss,(Name/DBA: (( ® �/frJ�O <br /> is conducted at Business Location: <br /> i/J (� / �O/ / ' / / /'/��� <br /> Business T e: y"/�✓T�`�A/ -Z-2 <br /> New [ j Renewal ( ] --Commercial [ ] Residential [ ]LEmail <br /> Address: <br /> Business Mailing Address: /,yy��t�� <br /> Business Telephone: Home [ ]Cell [ ] Pho S % �/ AW; 3� <br /> by the following named persons: eV1311-1- <br /> Owner Name Owner Residence <br /> I certify under the ena 'es of perjury that 1, to the best of my knowledge and belief, have filed all state tax reruns and paid <br /> o� <br /> all state taxes as q d law. ✓cJ �2� <br /> 'Signature of authoriz agent *' -ocial Security Number(Voluntary) <br /> 'This license will not bei ued unless this certification is signed by applicant or Federal Identification Number <br /> In case of a gency <br /> NAME _F/ telv_ TELEPHONE NUMR: , � _ /1WWI <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-fling 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 a <br /> BARNSTABLE, ss DATE �3 <br /> Personally appeared before me the above-named RA An k l'_ r �� and made oath that the foregoing <br /> statement is true. <br /> A ceni a issued in accordance with this section shall be in force and effect for four year i date of issue and shall be <br /> renewed each fo there ter so long as such business shall be conducted and shall lapse and be i unless s renewed. <br /> Signed Notary PubliEP .MAYA <br /> S 'dR <br /> • Commission Expirestt7NWEAL�t�ry pabfic <br /> X25,2DtE&tre1 <br /> i <br /> i <br />