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% BUSINESS CERTIFICATE k2/y y"d6i(e <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE16 � <br /> Expiration Date: 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 . <br /> I A S"C"Corporation Business Name/DBA: �>'�ch rlA,�p(�, il)ty nn�U Ir�Q Corporation Name: <br /> J — �Il1�peLcM° <br /> is conducted at Business Location: N ommercial_/ Residential <br /> Business Mailing Address: 1L <br /> Busine`ss/T/ e: orlitcnoi na Business Telephone: <br /> New ]V Renewal [ ] Home Phone: z(l L4 <br /> Email Address: �1��U[Z! 45 ` ��/' (lT LLVK� <br /> by the following named persons: <br /> Owner Name Owner Residence <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 required y'nd <br /> lY bi 0-b2&?2_ <br /> `Sig ature 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: JoniAif' , Telephone Number: <br /> Alarm Company: <br /> non� <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 S <br /> Personally appeared before me the above-named and made oath that the foregoing statement is true. <br /> A certificate issued in accordance with this section tall be in force and effect for four years from the date of issue and shall be renewed each <br /> four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> PN <br /> NdQ'dT�PXi SEM <br /> SEAL Po_ ,2020 <br />