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I <br /> BUSINESS CERTIFICATE a3 <br /> • TOWN OF MASHPEE <br /> Date: /,.7El <br /> Expiration Date: glLli�A "71 a0 i A� <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as <br /> amended,the undersigned hereby declare(s) that a business under the title of <br /> Corporation Name:ClnO ( orOCO�uBusiness Name/DBA: doe— <br /> nO <br /> loAl� � <br /> IV <br /> is conducted at Business Location: 16— [�a <br /> /"A r, r--. <br /> BusinessType:na1e- CJ �cc�7 �lOr���� <br /> New[Yi R/enewal [ ] --Commercial [ ] Residential [ ] Email Address: 9 O�COALlk. <br /> • n�{— <br /> Business Mailing Address: I 0r m6 rl 44C p_ C_oM cc6t <br /> Business Telephone: Home [ ]Cell [/p1hone: S0L_23.9-3LOSr <br /> by the following named persons: <br /> n / Owner/Name 1 / �y Owner Residence / <br /> C ) f�P �/P (/ yQtZ"l/Pl/P /s­ C4MOrr �� c I/r <br /> I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all stat taxes as required under law. <br /> .1._ c -' t-L�c�1Ll how/.— 0 3 � �2 <br /> "Signature of uthorized agent "Social Sp_curity Number(Voluntary) <br /> *This license will not be issued unless this certification is signed by applicant or Federa I Identification Number <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 tax <br /> filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or <br /> revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE, ss ' DATE C_ t 2ci U <br /> Personally appeared before me the above-named S-1k P 1]-e &U�_k2([P nd made oath that the foregoing <br /> statement is true. <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be <br /> renewed cac ,f or years thereafter so long as such business shall be conducted and shall lapse and be void unless s rene ed. <br /> • Signed Notary Publi <br /> Commission Expires _-:to 11 <br /> Notary Public <br /> c'>>' .RAargaret C.Santos <br /> Common ti eallh of Massachusetts <br /> ESKY <br /> Commission Expires on Sept 22,2017 <br />