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b�r , <br /> BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE <br /> Date: -301r1 - CX /p <br /> , JZ /Y <br /> t h` <br /> Expiration Date: S�"7 c,26 <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as <br /> amended,the undersigned hereby declare(s) that a business under the title of <br /> Corporation Name: Business Name/DBA:&MOAUA 1-14 <br /> is conducted at Business Location: <br /> Business Type: ynl'� LIft 91/,'$m 11anemu <br /> New[✓] Renewal [ ] --Commercial [-fResidential [ ] Email Address: �YYt ►�aG10o�C &o/-&M <br /> Business Mailing Address: 61 V[ � SiVi <br /> Business Telephone: ',00' 00 Home [ ] Cell [vf Phone: oZ3y' '�i /373 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> �MI��. KErr ►ru5let? cTnyt2 �V�rr- 14045Lble <br /> • -mast- pt/Q /- - 0 ?A izlz/gg <br /> 1 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 taxes as required under law. <br /> 4(-�✓f lwat'� <br /> " ignature of authorized agent "Social Security Number (Voluntary) <br /> *This license will not be Issued unless this certification is signed by applicant or Federal Identification Number <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 <br /> filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject 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 Afassachusetes <br /> BARNSTABLE, ss DATE �Zg12741 <br /> Personally appeared before me the above-namedSm,C KAZl UJIeX dv 4PI fnd made oath that the foregoing <br /> 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 <br /> renewed/e/a'�four years er-eQaft_er,,so Ion as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed " r r " �W�" s - _. Notary Public M.Klf Ou)en.5 <br /> c ��]� <br /> =Jner <br /> ICommission Expires AP106 242,0 <br /> J <br />