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BUSINESS CERTWICAWE# l3 l <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWNOFMASHPEE <br /> DATE o! <br /> • 0 CID &Ze- 3/ Dole— <br /> In <br /> Date: � <br /> In conformity with the provisions of Chapter 110, §5 ofthe Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title of V <br /> Business Name/DBA: et&a. kACSa9r corporation Name: <br /> is conducted at Business Location: u aSa Commercial_ Residential— <br /> Ahk <br /> Tim-co ftf vt 15C Sou-PL S't. <br /> Business Mailing Address: s:oAdA O M .CAW - <br /> �'i..6. Bac 1,5!10- ka5kf&L MA- oa4Y9 50 0-51elfl <br /> Business Type: Business Telephone: <br /> New ( ] Renewal [ X] Home Phone: <br /> Email Address: / <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> �c[c�a Ma„ �; �i ►I a Sh,etl bade- <br /> Second Owner Name Second Owner Address <br /> fy 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 /> s as required under law. <br /> 'Signature of authorized agent "Social Security Number or <br /> or Federal Identification Number(Required) <br /> "This license will not be issued unless this certification is signed by applicant <br /> Aa <br /> �� I� _ In case ofemergency <br /> syn /apt' q <br /> Name: Marx "IIaTfN1aYL��I�S6a44o1 1 Telephone Number:(' / "/Y I c r 7 — 73► <br /> .Alarm Company: J <br /> **Your social security number will be furnished 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 request <br /> is made under the authority of Chapter 62C, §49A of Massachusetts General Laws. <br /> The Commonwealth ofMassachuserfs <br /> BARNSTABLE ss DATE a' <br /> Personally appeared before me the above-named FQ uda l M a N'z i and made oath that the foregoing 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 renewed each <br /> four years thereafter so long/ads such business shall be conducted and shall lapse and be void unless so renewed. <br /> Si ned �, t DA ( I � VI/i/j� A <br /> �(,gaeb �>'L�.l�, Notary Public <br /> " SEAL c Deborah Dami - <br /> NOTARY PUBLIC <br /> Commonwealth of Wssacnuselis Commission Expires: <br /> My Commission Expires July 29,2016 <br />