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r108 r BUSINESS CERTIFICATE# THE COMMONWEALTH OF MASSACHUSETTS TOWN OF MASHPEE DATE v}; • ,Q,2 - 2c�/r�l Expiration Dat' '? Y nformity with the provisions of Chapter 110, §5 of the Massachusetts General Laws,as amended,the undersigned hereby declare(s) t at a business under the title of Business Name/DBA: AY WF R l GG f-/ /L L Corporation Name: is conducted at Business Location: Commercial_ Residential_ Business Mailing Address: ,?2 FA/MGvi H 1q011 to MA.<f{PicC. /)1#9 Z(,Y'' Business Type: /iJL/I Business Telephone: New ]✓] Renewal ( ] Home Phone: . Sn8 9 c%9 / 77� Email Address: �naNA � .� t2 R7 OY�1 Prov. GU• IJk by the following named persons: Owner Name Owner Residence iA Af]21e�F� 72 I=AI-Mi,t,TH R619() MA Mfl Second Owner Name Second Owner Address ify 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 as required under law. *Signature of authorized.agent "*Social Security Number or or Federal Identification Number(Required) *This license will not be issued unless this certification is signed by applicant In case of emergency Name: Telephone Number: Alarm Company: **Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment.obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Chapter 62C,§49A of Massachusetts General Laws, The Commonwealth of Massachusetts BARNSTABLE ss DATE Personally appeared before me the above-named and made oath that the foregoing statement is true. 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 four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. ed Notary Public SEAL Commission Expires: i