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BUSINESS CERTIFICATE# <br /> yY <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> • Expiration Date: <br /> In conformitywith the provisions of Chapter 110, §5 ofthe Mas;achusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title of /�25-'�r1clr>� <br /> Ary <br /> Business Name/DBA: C/ �liT/ /�l/�2�//�/ r Corporation Name: <br /> is conducted at Business Location: //OF ///l Gsr Sf' Commercial_ Residential <br /> Business Mailing Address: / �� t 1/. <br /> Business Type: W��� n� ' �y�� Business Telephone: <br /> New ] Renewal [ ] Home Phone: <br /> Email Address: 'CdI <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Second O per Name Second Owner Addres <br /> Ortify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes-as.euired undde7r law. <br /> *Signature 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 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 <br /> BARNSTABLE ss DATE20]({ <br /> Personally appeared before me the above-named YTG h GR e 1('C1 S 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 tb after so long uch b iness shall be conducted and shall lapse and be void unless so renewed. <br /> it Notary Public Not •Public <br /> Margaret C.Santos <br /> Commonwealthof Massachusetts — a a - Dot—) <br /> !LY CmmNselonEX IfesonSent.22.2017 Commission Expires: <br />