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Xwith <br /> BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: <br /> In confarmi provisions of Chapter 110,§5 ofthe Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title of <br /> Business Name/DBA: 5/�-lam. .d C-Q✓P /Iff"°Eorporation Name: <br /> is conducted at Business Location: JO 61-�,. nom, Commercial Residential_ <br /> Business Mailing Address: _� C.�'\� !�� 0-40 IA-e- <br /> Business Type: �e_ldLt�l� Y�� t`T!/l.�' rQ Business Telephone: <br /> New J J Renewal Home Phone: <br /> Email Address: ;4) -o-a-P-lJ S <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> T is y C �qe/ zX/:::�cyn iaC&4JLe_ <br /> Second Owifer Name u Second Owner Address/, O �/ <br /> Jo <br /> 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 under law. <br /> 3 9 � v v `r <br /> *S�aiure 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 /> / n ��C ��� In case of emergency <br /> Name: f`T-c-�����y o p / Telephone Number: <br /> Alarm Company: a� (/ <br /> "Your social security number will be famished to the Massachusetts Depanmcnt 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 he subject to license suspension or revocation. This request <br /> is made under the authority of Chapter GZC,§49A of Massachusetts General Laws. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE S <br /> Personally appeared before me the above-namekeo–nYt0_�FI r 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. l� <br /> Signed � J <br /> No 'P li <br /> SEAL <br /> PATRICETYNAN <br /> Ww'Conimlsslon <br /> ComiTJptglyiFiblf�es: <br /> Commorreeaflh of Momchtisob <br /> B ires November 3,2D17 <br />