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• BUSINESS CERTIFICATE# 4-0 6J <br /> THE COMMONWEALTH OF MASSACHUSETTS A <br /> TOWN OF MASHPEE <br /> DATE <br /> • <br /> Expiration Date: �3r <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 of / / <br /> Business Name/DBA: �T 5 Corporation Name: 41"Di.,) -/a/I12 '&)o L <br /> is conducted at Business Location: /v1a;If__ Commercial V Residential_ <br /> Business Mailing Address //: 6 <br /> Business Type: QC pt1! 1 aH A&II G(�v l�+�usiness Telephone: SV O go � ^7(000 <br /> New ] J Rome/Home Phone: S (O B 7� LOVtO <br /> Email Address: <br /> by the following named persons: <br /> Owner Name / //� / Owner ,Residence / ��(/� <br /> gitu 5)N L LC 10 i N � ti 4 I N <br /> t� <br /> Second Owner Name Second Owner Address <br /> 0ify 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 requir J tende law. <br /> ao1135/ �(0 <br /> gnature oth r'zed 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 lax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. -chis request <br /> is made under the authority of Chapter 62C. §49A of Massachusetts General Laws. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE 5' <br /> Personally appeared before me the above-name 1t-A00t.t 27 o and made oath that the foregoing statement is true. <br /> A certificate issu_cd4rrntSordancc with this section shall be to fo and effect for four years from the date of issue and shall be renewed each <br /> four years thereafter ong as sue business shall be conducted and shall lapse and be void unless so renewed. <br /> R. <br /> AL NO Y PUBLIC <br /> OOtF.AONNTMATa OF tIkSSACMUSErrS <br /> 020 <br /> mi stoti -s t es: <br />