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rr 'J BUSINESS CERTIFICATE k 3 <br /> i, <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE �COJ 1 aG IV <br /> Expiration Date: Ja ' 3 0 oY' 1 <br /> In conformity with the provisions of Chapter 1 10, §5 of the Massachusetts General Laws,as amended,the undersigned hereby decIare(s) <br /> that a business under the titleof <br /> / <br /> Business Name/DBA: C� C u�� /%/1P 1�meS Corporation Name: <br /> is conducted at Business Location: 7l Commercial_ Residential ✓ <br /> Business Mailing Address: �3 lA/ D�c /w./� ` l�c� A4 2 n <br /> Business Type: ��� CS%�T Business Telephone: <br /> New ]✓] Renewal ] ] Home Phone: <br /> Email Address: C�OPGo��A2�P/!e �J ('p M CGI'%. /iv r <br /> by the following named persons: <br /> Owner Name /' p Owner Residence <br /> Jyl/ e,, K /� U,7 CJ <br /> Second Owner Name Second Owner Address <br /> Ortify under the penalties of pe 'ury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as required under law. <br /> Day SZ v'9 9S <br /> *Signa[u a 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 lax <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 Commm <br /> ovealth of Massachusetts <br /> BARNSTABLE ss DATE QVQ .�G 1y <br /> Personally appeared before me the above-named fAar l en a SUS i er1 kc, and made oath that the foregoing statement is true. <br /> A certificate iss in accordance>1 is section shall be in force and effect for four years from the date of issue and shall be renewed each <br /> four years thereafter s g as such bus' shall be conducted and shall lapse and be void unless so renewed. <br /> 0 c <br /> Not=Public Note Public <br /> SEAL ®� L MargaComrno wttaMyCAmmiSsionCommission Expires: <br />