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BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE <br /> Date: Q / <br /> Expiration Date: <br /> In conformity with the provisions of Chapter 110, §5 of the Massachusetts General Laws, as amended, the <br /> undersigned hereby declare(s) that a business under the title of <br /> Business Name/DBA: L F_ 4 C i iv / SZE&2j t,�Zcqporation Name: <br /> is conducted at Business Location: d RA Certificate No. <br /> Business Type: Corvine Ela / Fin .v.on. inG <br /> New [ ] Renewal [.]Commercial [] Residential [ ] Email Address <br /> Business Mailing Address: P. O. 80-k 1 -7,5-6 <br /> Business Telephone: S-02-A- -3 9-J, 3,10 Home [-] Cell [ ] Phone: Sd - zL77 -.5-1044 <br /> by the following named persons: <br /> /� Owner Name Owner Residence <br /> i t r y (��e /� 463 /� � & e- n s kv Ro 3 d <br /> I certify under the penalties of perjury that 1, 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 /> 5W,6 <br /> *Signature <br /> 'Signature of authorized agent "Social Security Number <br /> *This license will not be issued unless this certification is signed by applicant or Federal Identification <br /> Number(Required) <br /> In case of emergency <br /> NAME:-//a n o /r/ 1, o /c/ TELEPHONE NUMBER: S02'S 3 5-.2 3/o <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 subiect to license suspension or <br /> revocation. This request is made under the authority of Chapter 62C,4 49A Massachusetts General Laws <br /> Tire Commonwealth of Massachusetts <br /> BARNSTABLE: ss DATE_ / <br /> ., T L <br /> Personally appeared before me the above-named i /,1, -�rG and m de 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 rom the date of issue and shall be <br /> �newed each four years thereafter so long as such business.shall be conducted and shall lapse and be v i unless so renewed. <br /> Signed Notary Public <br /> Q� Deborah Dami <br /> NOTAL &Vxpires <br /> Commonwealth of Massachusetts <br /> My Commission Expires July 29,2016 <br />