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BUSINESS CERTIFICATE Qo1f0 <br /> TOWN OF MASHPEE <br /> • Date: Aril V <br /> Expiration Date:2L'r_X � <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: Business Na//me/DBA: I ✓09.1kj" ��C✓Cliosy <br /> is conducted at Business Location: � G�i FG 1"'wA RZ . 4IA—2y z!sJhptG ,tu L eye <br /> Business Type: L/BSst04- <br /> New[X] Renewal [ ]—Commercial[ ] Residential [ ] Email Address: �hGJRi <br /> Business Mailing Address: /027 hod r7 /z "44 <br /> Business Telephone: S_00'"#'S7/d —Home[ ] Cell['hone: ,$70,' <br /> by the following named persons: <br /> Owner Name Owner Residence A, ` / / <br /> lec 4,9 Ar ZC� aka <br /> • I certify under the penalties of perytiry that I,to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all state taxes as required under law. <br /> /0 0/ 30970� <br /> Signature of aut rized agent "Social Security Number(Voluntary) <br /> 'This license will not be Issued unless this certification Is signed by applicant or Federal Identification Number <br /> In case of emergency c'�, <br /> NAME: CuAr/n Loo t++t TELEPHONE NUMBER: -;r AS t9' (5r3 j( <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 subiect to license susoension 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 �R✓�K. j-1 eZOI Y' <br /> Personally appeared before me the above-named k a ltd-Jer LoJI 44 and 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 yearKmm the date of issue and shall be <br /> renewed/ea/c/y rXearVhereafter so long as such bu ' ess shall be conducted and shall lapse and be vpif unless so renewer. <br /> signed,, Notary Public 6 , <br /> • Commission Expires <br /> Deborah Dami <br /> ']}I} NOTARY PUBLIC <br /> �[ Commortwulth of Massachusetts <br /> My Commission Expires Jury 29,2016 <br />