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BUSINESS CERTIFICATE# 0Q.17—St <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWNOFMASHPEE //3 m/ <br /> DATE `'/ � (y <br /> • Expiration Date: y 30 D <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: Corporation Name: <br /> isconductedat Business Location: 31 t34 /3f(t(ty atkyo-- Commercial_ Residential <br /> Business Mailing Address: , S�—Q_ <br /> Business Type: 5—cl.ge_ Business Telephone: <br /> New [./['�_ Renewal [ ] Home Phone: <br /> Email Address: ��� ������ e��•• w^ <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> oS hj/-v u <br /> Second Owner Name Second Owner Address <br /> OTwired <br /> der 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 /> under law. <br /> /Lf� G6 X23 s <br /> of authorized agent **Socia <br /> umber 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 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 of Massachusetts , L <br /> BARNSTABLE ss � DATE `T <br /> Personally appeared before me the above-named A d and made oath that the foregoing statement is true. <br /> A cerli t 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 the a o ng as such business shall be conducted and shall lapse and be void unless so renewed. <br /> �d <br /> J6ffil%L#! CCHEW,JR. <br /> SEAL NOTARWPUBLIC <br /> COLBAMWEALTH OF MASSACHUSMs <br /> t�k�ik34,2020 <br />