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BUSINESS CERTIFICATE 116 <br /> TOWN OF MASHPEE <br /> • Date: <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as <br /> amended,the undersigned hereby de//clare(s)that a business under the title of // <br /> Corporation Name: 7�J�-a/&—/5 T/Y_ Business Name/DBA: %D 1i70A <br /> is conducted at Business Location: <br /> Business Type: fi//Dmd4 k roiai/ <br /> New[ ] Renewal [ y]—Commercial [ ] Residential [1] Ema�ill Addr/ess: <br /> Business Mailing Address: ZW O-T0�3 <br /> Business TGglep-�)pQne: fp/-Yy/- lal-V Home [ ]Cell [ ] Phone: l SD8 X39- 7030 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> 49n <br /> • I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all state a as required and law. / <br /> T'/_//l&ld9 <br /> *SiOr6re of authorized age "Social Security Number(Voluntary) <br /> •This license will not be Issued unle is certification is signed by applicant or Federal Identification Number <br /> In case of emergency <br /> NAME: A11717Cy f/2-7e- TELEPHONE NUMBER:v�OP- 11Y51- 9Z:� 7 <br /> Alarm Company: <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax <br /> filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subsea to license suspension or <br /> revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE, ss dee- aA0_CR'e'( DATE <br /> Personally appeared before me the above-named and made oath that the foregoing <br /> statement is true. <br /> A certificate issued in accordance with this section shall be in force effect for four years from the date of issue and shall be <br /> renewed each four years thereafter so long as such business shall be wnd d and shall lapse and be void unless so renewed. <br /> Signed Notary Public <br /> r <br /> • ( Commission Expires <br />