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i. BUSINESS CERTIFICATE 4 O' )I L y <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWNOFMASHPEE <br /> DATE y � <br /> • Expiration Date: <br /> In conformity with the provisions of Chapter 110, §5 ofthe Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title of <br /> Business Name/DBA: Corporation Name: / <br /> is conducted at Business Location: 1� /tK�,[/— .4/ Commercial_ Residentiald <br /> Business Mailing Address: Z� 0,, &AS�N/f <br /> i <br /> Business Type: Business Telephone: <br /> New [ Renewal ] Home Phone: <br /> Email Address: <br /> by the following named persons: <br /> Owner Name - Owner Residence <br /> sSecond Owner Name Second Owner Address <br /> Ortify 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 /> taxes <br /> *Si on d 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: ���/��0��� Telephone Number: �F(��O�/�� <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 ol'Chupter 62C. §49A of Massuchusetts General Laws. <br /> The Coninionwea(rh of Massachusetts ,J <br /> BARNSTABLE ss DATE�� <br /> Personally appeared before me the above-named��� G I' t�0' '/Lnd made oath that the foregoing statement is true. <br /> A certificate issued in accor ante 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 c siness shall be conducted and shall lapse and be void unless so renewed. <br /> SEAL ' J 'lAk6CCHEUI,JR. <br /> NOTARY PUBLIC <br /> l EA011 '0&16,2M <br />