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BUSINESS CERTIFICATE '�� / <br /> • TOWN OF MASHPEE <br /> Date: <br /> Expiration Date: `f / <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 n I <br /> Corporation Name: cc Business Name/DBBA:pWnoaJ2ywies 14DwP bat�eore <br /> is conducted at Business Location: I.M Say ,t, — UF7r-A <br /> ( Kit <br /> Business Type: l u CCL <br /> New[Renewal [ ] --Commercial [ ] Residential [ ] Email Address: <br /> Business Mailing Address: I V O So t/1 to <br /> Business Telephone: l)" Home [Cell [ ] Phone: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> l San4t',: k V NOSY,, <br /> e� <br /> 1 certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all stattTtaxes as required w dci aw. <br /> 2& - I �06t057 <br /> *S natu of authorized **Social Security Number(Voluntary) <br /> *This 'Ise will not be issued unless this certification is signed by applicant or Federal Identification Number <br /> In case of/emergency Q (( <br /> NAME: l .62A 12 D TELEPHONE NUMBER:—17 <br /> 71F- SZI- 1P[S5 <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 /> fling 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 Connnoatvealrh of Massachusetts <br /> BARNSTABLE, ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing <br /> statement is true. <br /> A certificate issued in accordance with this section shall be in lorce and effect for four yens from the date of issue and shall be <br /> renewed each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> • Signed Notary Public <br /> Commission Expires <br />