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BUSINESS-ZERTIFICA<TE# L L <br /> r THE COMMONWEALTH OFMASSACHUSETTS <br /> TOWN OF MASHPEE DATE SA2 12 <br /> Expiration Dat d� <br /> conformity 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 <br /> Business Name/DBA: �I I �t7 X 'bef) Corporation Name: OL �/L¢ <br /> is conducted at Business Location: [ M(L1 h S4 Commercial— Residential <br /> Business Mailing Address: I C' k,✓) P-ea VVILti 2 <br /> Business Type: l_A+e ( I n�, / M o b s I Business Telephone: g J a 2—V (o 7 <br /> New [� Renewal [ ] Home Phone: . <br /> Email Address: Q <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Second Owner Name Second Owner Address <br /> 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 <br /> as required under law. <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 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 Commonwealth of Massachusetts <br /> BARNSTABLE ss / r\��r� ( DATE �/lfI <br /> Personally appeared before me the above-named ShWQ `�""a'I't�Oj�'E'- grid made oath that the foregoing statement is true. <br /> A certificate issued in jaCRoNance 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 r longch b sines she[ o ducted and shall lapse and be void unless so renewed. <br /> Signed <br /> m r <br /> ., N tary Public <br /> L Notary Public <br /> Cemmomvne Margaret C.Santos q - a- c)01-7M CeOin . °Commonwealth of Massachusetts Commission Expires: <br /> frly Cbmmisslon Expireson Sept.22,2017 <br />