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BUSINESS CERTIFICATE # O 3� <br /> r THE COMMONWEALTH OF MASSACHUSETTS 3 ( 1 S t y Q t9- <br /> TOWN OF MASHPEE <br /> DATE 2_5� <br /> • Expiration Date: 3- 3 I— ao I <br /> In 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: (3 ( D✓� =-0 <br /> ;Zo'r('::.4 <br /> on Name: <br /> is conducted at Business Location: ( 8s ; '"Commercial_ Residential_ <br /> Business Mailing Address: 754 rn a c� <br /> Business Type: I w-e l_e0'1f �CGn ('uO'n 5 Business Telephone: 7-7 1/�r�Q�— 7,3 <br /> i <br /> New Renewal / Home Phone: <br /> Email Address: YY\GL yQ ' /(�'D lkaL )" •00&9 <br /> I <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> ��xAor �Gydr: Qa l QO -Si mons nar/Otos 4zi-d <br /> I <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 /> es as required under law. <br /> • tool- �9-� 3 2l <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 riling or tar <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. p49A of Massachusetts General Laws. <br /> The Commonrvea!!lr of Massachusetts <br /> BARNSTABLC ss DATE <br /> Personally appeared before me the above-named lrQOC ias I and made oath that the foregoing statement is true. <br /> A certificate issued in accordance with this section shall in force and effect r four years from the date of issue and shall be renewed each <br /> Tour years thereafter so <br /> to s,uch business shall be conducted and shall lapse and be void unless so renewed. <br /> C'.ned � <br /> =CG0nrMiSsicog)naE)0— <br /> PublicLary PubSEAT. 0. Santos +of Massachusetts <br /> on Sops.22,2017 Commission Expires: <br />