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v BUSINESS CERTIFICATE# 15-5 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> • Expiration Date: G 13 ii1r6 <br /> Inconformity with the provisions of Chapter 1 10, §5 of the Massachusetts General Laws, as amended,the undersigned hereby declare(s) <br /> that a business under the title of <br /> �t i <br /> Business Name/DBA: HQ UA- m rl fl. a p( .�( Corporation Name: <br /> is conducted at Business Location: 3 4 SQ VIrJ t -fax pP. Commercial_ Residential <br /> Business Mailing Address: fbX fk <br /> Business Type: CV,.44S Business Telephone: SDS— N77"jgpj <br /> New Renewal [ ] Ir Hom(ePhone: Jr�� ' u77- 1go <br /> + <br /> Email Address: Byte ii p4wa Le tDrA cai; net <br /> by the following named persons: <br /> Owner Name Owner Residence n <br /> RVV'n' Qe. Peale. �JN S� -fax 0L �vAS11Pe'2 <br /> Second Owner Name Second Owner Address <br /> Otify under the penalties of,perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as required under law. <br /> 6a3- 4S- R3GL <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 met tax tiling 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 Chapter 62C, §49A of Massachusetts General Laws. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE Qpm,. a21a 2.pl4 <br /> Personally appeared before me the above-named BYY r%4 6— 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 as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Deborah Dami LmaL <br /> ° &-,,- <br /> NOTARY PUBLIC Notary Public <br /> SEAL Commonwealth of Massachusetts <br /> My Commission Expires July 29,2016 <br /> . 1 Commission Expires: <br />