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f BUSINESS CERTIFICATE# Q-e) 1!L(3&6 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE—5 / 7 cv <br /> Expiration Date: 5 3f <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 5611 <br /> Business Name/DBA: 3R.A/f C-0 'S CLC A/U 1 S ortlfratfon Name: <br /> � <br /> is conducted at Business Lopcation: p I /Vim=�- /4 nLc DR r VI Commercial� Residential� <br /> Business Mailing Address: 7,^AiSCiLL'ciC ,/-)?- 1 VC <br /> Business Type: C L A ^t 14 Business Telephone: SobG <br /> - 5 7 Zd 6 S <br /> New ( ] Renewal [� Home Phone: <br /> Email Address: $p-.A^t coS LLcaNfw& fj0 uSA •CQA1 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> 1J / ISO f <br /> 7L/ 2 <br /> Second Owner Name Second Owner Address <br /> Wcertifyunder penalties of rjury that I, to th best ofmy knowledge and belief, have filed all state tax returns and paid all state <br /> nder law.orized 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: I,/En!E t b z M c-XJc(2� Telephone Number: 5 69- b p. <br /> Z 6 7 5S- z <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 of tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license susnensinn or revocation. This request <br /> is made under the authority of Chapter 62C. §49A of Massachusetts General Laws. <br /> Tire Commonwealth of Mrrssnchusetbs LJ <br /> BARNSTABLE ss / /� �""� (' DATE S Z � � / <br /> Personally appeared before me the above-named IS O2f ` M4t - /va�ntDmade oath that the foregoing statement is true. <br /> A cent ficat•'slued in accordance w h this section shall be in force and effect for four years from the date of issue and shall be renewed each <br /> f r years thereafte long such busme , shallbe on ted and shall lapse and be void unless so renewed. <br /> SEALt Q JOSEPHL CCHEW,JR. <br /> BNG— <br /> }, X11<UWjp94€tP{pPRt&WHa5ETT5 <br /> Wy Comm.Expires Oct.16,2020 <br />