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BUSINESS CERTIFICATE N 142- <br /> TIM, <br /> `T2THE COtbltI90A'IVEALT11 OF 1VASSACfIUSETTS <br /> TO IVA'OF AIASTIPEL _ � <br /> DATE 3oLn.Jf� . a.o—L(7 <br /> • Expiration Date: off— L ti 0 144. <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declare(s) that a business under the title of <br /> Business Name/DBA: �+t',l �S mY(�Corporation Name: is conducted at <br /> Business Location: 8a Ybrsesh'a-P, Rend _ t.L -M4 s6ptc, ma . <br /> Business Nlailing Address: 82 R arnd Luam f Mt_C100Ce—,Aka <br /> Business Type: MCLANI& P0O=L&!_BusinessTelephone: 50%-S39-0059 <br /> Homtc Phone: _5U$-S A� rMD"l Entail Address: AQArC 4S��n (v °t�W'�Ld. 1� •r��' <br /> dod%eS 4-r' t L'6ev j G&un-\C-0-sk r -+ <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> c l;ci r. re f]- FAGr5c.9ncr--_ReY1d VJC"ft _ <br /> Afi- 0-ac't'1 <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 all state <br /> taxes as required raider law. <br /> - Q Cc s -n()41law5 <br /> gnature of and rized&, tt "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <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 filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subiect to license suspension or revocation. This request <br /> is made under the authority of Massachuseus General Law,Chapter 62C,Section 49A. <br /> The Commonwealth ofillassachuserts 3O Z.O (o <br /> BARNSTABLE ss DAT <br /> Personally appeared before me the above-named me l l.5`� U o Wll and made oath that the foregoing statement is <br /> 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 <br /> each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed 4 (A4 ^ � <br /> Gt� <br /> Notary Publi&----___) <br /> SEAL wh DOW <br /> t� NOTARY Commission Expires: <br /> wE b <br />