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BUSINESS CERTIFICATE#,761/ <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 2 <br /> Expiration Date: <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 /> l <br /> Business Name/DBA: 1, (—= Corporation Name: <br /> is conducted at Business Location: 25q 5...,,.e� M P6 _�Q19 Commercial Residential_ <br /> Business Mailing Address: 170 l�o X 3oZG 1�k,��Zn�e ✓ glgl OZS3 Z <br /> Business Type: {'_J t],t( SA Lo t, Business Telephone: S-69-469_ 1 — Q6 5zl <br /> New [ Vf Renewal [ ] Home Phone: 62 Z 95,5 — ZZZ <br /> Email Address: JavyXeop (QC&.VL<y9-5T, t—%QA <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> L� <br /> Second Owner Name Second Owner Address <br /> 16ify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed al I state tax returns and paid all state <br /> taxes as requir e undlaw. <br /> *Si a uthorized 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: WI AT7tzjC Telephone Number: 77L[ —'j��j-077—c4 <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 Contmouwen71hoMassachusetts / <br /> BARNSTABLEss DATE <br /> Personally appeared before me theabo -name and made oath that the foregoing statement is true. <br /> A certificate issued in accordance with this section s al ore,and effect for four years from the date of issue and shall be renewed each <br /> four years thereafter so long as such bu ness shall be conducted and shall lapse and be void unless so renewed. <br /> Y <br /> SEAL JOSEPH L�g2•Z000HEW,JiL <br /> NOTARY PUBLIC <br /> my Comm. 16,2020 <br /> MIT <br />