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! ' BUSINESS CERTIFICATE -2.% 1*3 — a <br /> TOWN OF MASHPEE 2 <br /> Date: J <br /> • Expiration Date: e3 I <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 (ad <br /> n� nn � <br /> Corporation Name: Business Name/DBA: e ( r7 Ea-Am 5/-D_ <br /> is conducted at Business Location: J?�f QULLS 11 P� Q j d a< wee. <br /> a <br /> Business Type: F/f K-ff) a44j- a4ed 5_undJJf;ej <br /> New [ ] Renewal [QxCommercial [ ] Residential [ ] Email Address: <br /> Business Mailing Address: S ez4y DLA <br /> lephone:L� y77-&50- }tome [ ] Cell [ one: 1/0 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Weml, M • Air-f7 3/ lli?54nef <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 <br /> all state taxes as required under law. <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 /> a'. ; <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 of Massachusetts <br /> BARNSTABLE, ss I, ' DATE <br /> F 12D <br /> Personally appeared before me the above-namedu)LGA . leFL - and made oath that the foregoing <br /> statement 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 <br /> renewed eaclifour years ther r so Ion as such business shall be conducted and shall lapse and be void unless so ren • .�[/} <br /> �igned .X/�'I Notary Public "�'� <br /> note ry Public Commission Expires a-4_)00 <br /> Margaret�® C.Santos ;Commonwealth of Massachusetts <br /> My Commission Expires on Sept 22,2017 <br />