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pLQ' <br /> BUSINESS CERTIFICATE /3 03 / <br /> TOWN OF MASHPEE <br /> Date: 3 <br /> Expiration Date: 3/ <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 /> >Js B� ays: u� <br /> Corporation Name: b Business Name/DBA: <br /> 1;.ao3 e-rA'eo <br /> Is conducted at Business Location: 95 Shore Drive West <br /> Business Type: Country Club <br /> New [ ] Renewal [V] --Commercial [✓] Residential [ ] Email Address: <br /> Business Mailing Address: 20 Red Brook Road Mashpee ma 02649 <br /> Business Telephone: Home [ ] Cell [ ] Phone: <br /> by the following named persons: <br /> `702-Sd'G - 8Z4 6 <br /> Owner Name Owner Residence <br /> 1-45-AbTalerRoad' Sc �(0l 1 , "P-C/o 5 QD �SSo <br /> F7/4PGrP+� c�trti4i�mci i&,±-e, (kp �fe'\le25mr <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 /> aIst xes as required under law. V P ( q qk to <br /> , 'h 9 <br /> as Beek CLvB, LJ_(— <br /> GUS (3e,1u LL�s LLc. 13_ Lf 60 <br /> *Signatur f aVthorized agent **Social Security Number (Voluntary) <br /> *This license will not be issued unless this certification is signed by applicant or Federal Identification Number <br /> In case of emergency <br /> NAME: r i eL/, TELEPHONE NUMBER: <br /> Alarm Company: SeHSrDa <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 DATE J // <br /> Personally appeared before me the above-named NJ 4"i SP(;A.)f4Qi and made oath that the foregoing <br /> statement is true. <br /> A certmate 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 each fdu years thereafter so long as such business shall be conducted and shall lapse and b id unless so renewed. <br /> •Signed I/ Notary Publi <br /> y JOSE; i L. MAZZUCCHELLI,JR <br /> �Q I u - �/J'li/✓ 'L trZ/C� Commissi r \c:ary Public <br /> I OMMU.WV4: N Of MX5�AG"Ubtl I* <br /> S My commission Expiras . <br /> OctOW 2S,2013 <br />