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BUSINESS CERTIFICATE # 0,22 <br /> 1 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE March gi c2o� <br /> .'` Expiration Date:(Y)Circ), 3k QOI <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: Corporation Name: <br /> is conducted at Business Location: M Commercial_ Residenti <br /> Business Mailing Address: <br /> Business Type: s\ 'I �'� Business Telephone: <br /> 'r <br /> New M] Renewal ]' ] Home Phone: . �7M '3 /• Zai <br /> Email Address: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> � <br /> Second Owner Name Second Owner Address <br /> �tify rider 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 a equired under I <br /> 2S 7 1 <br /> gnaturI <br /> hori d 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 tax tiling 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 Comntonivealth of Massachusetts BARNSTABLE ss �^ DATE YYv4 r c h 10. .7U I <br /> Personally appeared before me the above-named X-n 4. 12%c Co v and made oath that the foregoing statement is true. <br /> A cert' ncate issued in accordance with this section shall be n force end eff t for four years from the date or issue and shall be renewed each <br /> four years ther fter so long as suG ;3siness shall be conducted and shall lapse and be void unless so renewed. <br /> ened / (j <br /> Jo 0.�GG wl�P < �Cic.�vo <br /> ry Public Not# Public <br /> Margaret C.`Santos <br /> Cott mo wealth of Massachusetts q - a a - a 1, <br /> My Commission Expires on Sept.22,2017 Commission Expires: <br />