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BUSINESS CERTIFICATE# 20 13- 6a�L <br /> 4 THE COMMONWEALTH OF MASSACHUSETTS / 4 <br /> TOWN OF MASHPEE <br /> DATE 'a 1p, <br /> Expiration Date: 4 3 J A4q <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 /> Business Name/DBA: orporation Name: is conducted at <br /> Business Location: G S'-� <br /> T <br /> Business Mailing Address: It °J-e_ <br /> Business Typec(.,)J-- S' -" 31 U ""4`e re L" mess Telephone: �b �`E 4 30 <br /> Home Phone: <Z:;)&- G yt--y3vo Email Address: -+-Al-- t&i Loq ti G <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> S} v e l� PGJ rl c-- PL 1 I1 S i—Lt4 /J <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 ap 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 <br /> NAME:(�.n to 5/ "al 4E- /4ca n)CIZ TELEPHONE NUMBER:5yt� <br /> Alarm Company: <br /> "Your social security number will be furnishedtothe Massachusetts Department of Revenue to determine whether you have met tax filing or lax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will he suhiect to license suspension or revocation. This <br /> Fequest is made under the authority of Massachusetts General Law,Chapter,62C, Section 49A. <br /> I The Commonwealth of Massachusetts <br /> B%ARNSTABLE ss DATE <br /> ^ g-; Personally appeared before me the above-named c 47w K 410'e"�_nd made oath that the foregoing statement <br /> i's`iFue. <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 thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> SignedX�2_ <br /> L.MAZWELLl,JR <br /> SEAL COMMONWEAL oF <br /> tuS,SApgt3Eng <br /> on rea <br /> M ssionErx ��O�ter2S,Z013 <br />