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�BUSINESS<CERTIFJCATE# /a3 <br /> THE COtMMOIVWEAZTH OFMASSACHUSETTS <br /> TOWN OFMASHPEE <br /> DATE <br /> • Expiration Date: <br /> Inconformity 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 II -- � <br /> Business Name/DBA: 544,- 11A/ � corporation Name: <br /> is conducted at Business Location: !�! S�t7{'rJK�h 7�4ivlr[e/o• Commercial_ Residential <br /> Business Mailing Address: �'-sr ,7�nvtw (44 . <br /> t 2� <br /> Business Type: St,Wt(t0ON -Business Telephone: OSS xw c��tfp/I <br /> New G Renewal [ ] Home Phone: . <br /> Email Address: a / /� ICkstnei- <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> / I /cc' (bn Re/ # ;6L R <br /> d. <br /> Second Owner Name 'Second Owner Address <br /> 10eify under the penalties of perjury that I, to the best of my knowledge and belief, have filed aU state tax returnd paid all state <br /> s as required L/ <br /> *Sign to of authorized agent **Social Security Number or <br /> or Federal Id6tification Number(Required) <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> c <br /> Name: Telephone Number: <br /> Alarm Company: <br /> "Your social security number will be famished 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 ajMassachusens <br /> BARNSTABLE ss DAT of i Q'/y <br /> Personally appeared before me the above-named Dpr r'A _T Pro.,W 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 ofMsmesslbe conducted and shall lapse and be void unless so renewed. <br /> ed — ^ l <br /> o ary Public LGt� <br /> SEAL _Notary Public <br /> Margaret C.Santos c5e/ <br /> Commonweallhof Massachusetts Commission Expires: <br /> ®My Commission Ex Tres on Sept.22,2017 <br />