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c, BUSINESS CERTIFICATE 1351 TOWN'OF MASHPEE 1 Date: -2> Expiration Date: ndL-ern fa.,... 3- l a0 b' In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended,the undersigned hereby declare(s)that a business under the title of do Corporation Name: Business Name/DBA: I\nA P j NIt�I JAZ Q E ll E� is conducted at Business Location: Lib S C1LA G O r I V' M11-5NA1 , 1VA 0161`i Business/Type: SD)4 f' R I E7U✓L SYI� 00 5u) l New[VJ Renewal [ ] -Commercial [�t ] Residential [ ] Email Addres: i O Vlca vl"()US( P S WJA ti / Lvvyl Business Mailing Address: I c) 5 cM I L pV I Ir 44K)4 MA tg-6 Ll cl Business Telephone: G ( L-21(0 -olW Home [VECell [V] Phone: (o I Z] b — I r 7 I I by the following named persons: i i Owner Name Owner Residence SOti,+7-Y w e42 P-6 L, (_ LL S c M f_G Q>rf > 1-4±J lt�[,1144 491 certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid al state taxes as required under law. � - algayS- y ignature of authorized agent "Social Security Number(Voluntary) *This license will not be issued unless this certification is signed by applicant or Federal Identification Number In case of emergency ��ii n�,, NAME: Hta✓wl dv'i'y CA V r V I I TELEPHONE NUMBER: Alarm Company: Cg2e (-,)d '+/ir✓Inn "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subiect to license suspension or revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. The Commonwealth ofMassachasens BARNSTABLE, ss DATE not[ vn. ,c, tn.i 3o14 Personally appeared before me the above-named SUha,[-j'ta h P La f t d�( and made oath that the foregoing statement is true. 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 ch four years thereafter so lo/n/g as suc/h/I sin s shall be conducted and shall lapse and be void unless so renewed. �,p Signed �`"�—' Notary Pu ibf c 1 i L-- t-lNd "( Commission Expires D a- 11 Notary Public Margaret C.Santos CommoaRmn of Massachusetts MyCommbsbn res on 22,2017