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BUSINESS CERTIFICATE# ��//`�' 056 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE �n�1 <br /> • DATE //leu / '90 J!/ <br /> Expiration Date: 3 O/ <br /> inconformity 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 <br /> otf <br /> Business Name/DBA: !�®r �Q�/G'� Corporation Name: <br /> is conducted at Business Location: a2 I V /f Qtr / Commercial Residential_ <br /> Business Mailing Address: /�) ✓ /9 h^ s L'//Lc "� r � �194 f' <br /> Business Type: [^Z Al k fNle l✓e-C �G Business Telephone: �U� � O/7 7 � 6 <br /> New [tom] Renewal I I Home Phone: —s39 SOUS}/ <br /> Email Address: 2 ✓ 41L/—/^'1 I&__JC�l?ud <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> i Gly� <br /> Second Owner Name Second Owner Address <br /> certify 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 as required under law. <br /> t <br /> 7o 's"Z70 � Ys� <br /> *Signature of authorized agent "Social Security Number or <br /> i <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 famished 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 ���yyyyyy777 <br /> BARNSTABLE ss DATE/(meq <br /> Personally appeared before me the above-named � 6 Y <br /> 6ar f\a r h r.: and made oath that the foregoing statement is true. <br /> A certificate 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 fler iso;to s such business s acted and shall lapse and be void unless so renewed. <br /> otary Public <br /> pry <br /> �; :Notary Public <br /> — Margaret C. Santos <br /> 6ommomreaIOt of Massadlusetts Commission Expires: <br /> My Commisslo'n`Expfres on Sept 22,2017 <br />