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p BUSINESS CERTIFICATE#!0 7 G <br /> THE COMMONWEALTH OF MASSACHUSETTS 20 11 I p <br /> TOWN OF MASHPEE• 6 DATE 1 (4 <br /> y <br /> Expiration Date: ( O <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 /> Business Name/DBA: lsoloration Name. GVA L <br /> is conducted at Business Location: Commercial_ Residentia <br /> Business Mailing Address: t <br /> Business(Type: `> `\�Business Telephone: <br /> il <br /> New/I A__ Renewal [ ] V Home Phone: <br /> Email Address: <br /> by the following named persons: <br /> ,. Owner Name Owner Residence <br /> Second Owner Name Second Owner Address <br /> j <br /> nder the penalties of per' that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> equir un a laws <br /> - c � �� C) <br /> re u to . ed 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. This request <br /> is made under the authority of Chapter 62C. §49A of Massachusetts General Laws. <br /> The Commonwealth of Massaehuse rs <br /> BARNSTABLE ss DATE ZO <br /> Personal ly appeared before me the above-named and made oath that the foregoing statement is true. <br /> A certificate issued in accordance with this section sha c to force at t for—rou—ryNA from the date of issue and shall be renewed each <br /> four ars Cher after so long as suc bu iness s be conducted and shall lapse and be void unless so renewed. <br /> 01 PUBLIC <br /> SEAL COAMONWEALTH OF MASSACHUSETTS <br />