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+ BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE n <br /> Date: Y4-12(9rJ� <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 <br /> Corporation Name: 'C.+ L+ LAAJ& i,flm Busine�sls�Na�me/D�BtA: / ,� ISG+4P�y�tr <br /> is conducted at Business Location: '-Li / 'i �kd,*e I y�K t`�` / 'r�S Nie V%#' <br /> ' <br /> Business Type: A/tr/'SCgp�nW �/ <br /> New J�newal [ ] --Commercial [ ] Residential [ J Email Address: <br /> I_ M44k.- u4je 19 1/9 may.) 4Cv►�'1 <br /> Business Mailing Address: z � / '/��� ryGGK W 117/TJ�//� 'I�d2`� <br /> Business Telephone: '5W'5;2. Home [ ] Cell [ ] Phone: <br /> by the following named persons: <br /> Owner Nam��ej <br /> Owner Residence <br /> AAMk 1) /Spiq5h Ama-- RJ <br /> • I certify under the penalties of perjury that I o the b my knowledge and belief, have filed all state tax returns and paid <br /> all res as re red under law <br /> � <br /> 0.21? -sa- 890y <br /> `Signature of authorized agent "Social Security Number(Voluntary) <br /> *This license will not be issued unless this certification is signed by applicant or Federal Identification Number <br /> t. <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <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 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 ofMassaehuserrs <br /> BARNSTABLE, ss DATE 7 .J <br /> Personally appeared before me the above-named AX-fizz ( _and made oath that the foregoing <br /> statement is true. <br /> A certificate issued in accordance s sect' n all be in force and effect for four ears from the date of issue and shall be <br /> renewed each fou ars t reaft o Ion sr t usm s s II be conducted and shall lapse d b void unlcs renewed. <br /> iigned1256 <br /> Notary Public <br /> 2A 1140164inJUGHEI.I.I.JR <br /> Commission Ex s NotaryFubsc <br /> tiN cownissbn Eh�i y <br /> Ot7o0lr- .2015 <br />