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BUSINESS CERTIFICATE# ]N <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 1a-9- aO1l'I <br /> Expiration Date: la 31-aa14� <br /> Oonfortnity with the provisions of Chapter 110,§5 of the Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title of n �� <br /> Business Name/DBA: �' ( A�Q�V ck F Corporation Name: <br /> V 7 ]Legoiec5 <br /> is conducted at Business Location: Commercial_ Residential <br /> Business Mailing Address: �Si4�i�rGc Yet JI cls �O 9s� <br /> Business Type: 1-lt,36`e`mVvtn1-ePQ e- Business Telephone: <br /> New ] Renewall J) Home Phone: . <br /> Email Address: /�Nl��fGw A � rkal/� �da''t <br /> i <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> .n e1 `�in1c � IGS ISI movt�r�OkC �qo4 <br /> rhe �n� n S A,"Q, <br /> Second Owner Name Second Owner Address <br /> ify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax retums and paid all state <br /> as required under law. <br /> 331 <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 /> 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 mel 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 ComnrarwealiliojMassachuserts <br /> BARNSTABLE ss DATE CI <br /> j Personally appeared before me the above-named +'`le( lin l 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 therea s longas sch b usine all be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • otary Public <br /> Notary Public <br /> WMargaret C.Santos 9- <br /> 'commornre. of Massaehasells Commission Expires: <br /> y commissbn Ex on Se 22.2017 <br />