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'1 <br /> (. ^• BUSINESS CERTIFICATE n <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE "13 <br /> Expiration Date: •6 7 <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 /> „IEgNNE M• C-3APtAMr ``11 <br /> Business Name/DBA: Corporation Name: is conducted at <br /> '�I-NE G ttscc e� 9 opt t e,•►I E <br /> Business Location: _ r14 -W\ASk402.E -'DJZtVE <br /> Business Mailing Address: <br /> G eoc.etzN SMoYp t��a os flu. a08• 3 - 4� 1 z <br /> Business Type: :5hi1 Q 11 Business Telephone: 608 • 341 - -1-1 1 Z <br /> Home Phone: bOA• 362- 622.2- Email Address:s)rxCra-n� 2OO e h04 neuu L • C�M <br /> by the following named persons: <br /> ff Owner Name Owner Residence <br /> .JEA�4UE Q�.l.• CxrL1e.E.QUT U`^�'�U,TgHov,2.£ C�etVB <br /> N1�51tpEE , ttl,q 62(e.}•r-i <br /> I 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 /> ignature 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 famished 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 <br /> request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss rf,,,� �t fi DATE <br /> Cf 6:141 <br /> Personally appeared before me the above-named JNyr^ W dA- -_au % and made oath that the foregoing statement <br /> is 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 thereafter so Ig as su usiness shall be conducted and shall lapse and be void unless so ren e <br /> Signed <br /> SEAL <br /> Public <br /> My Expim <br /> otamer 2f,aota <br />