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BUSINESS CERTIFICATE#AO-L5-D <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> 'j TOWN OF MASHPEE ao 1 <br /> DATE o <br /> Expiration Date: Q <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 QQ <br /> Business Name/DBA: I� s � G17 VLl Corporation Name: T J ICI 112 19S t NC <br /> is conducted at Business Location: oe t Commercial �1Residential_ <br /> Business Mailing Address: - 0"4I 1 <br /> Business Type: S 7/1.P r-a &'-I Business Telephone: 9ov <br /> New SK—] Renewal ] Home Phone: <br /> Email Address: 1-1*1. 1104 P Al enVy r G OY1i1 <br /> by the following named persons: <br /> L <br /> Owner Name / /O_w'nerReesidence <br /> 0232 <br /> hrntil /y <br /> Second Owner Name Second Owner Address <br /> Ofy under 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 as required under law. <br /> *Signature of authorized agent "Social Security Number or <br /> or Federal Identification Number(Required) <br /> i <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 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 /> Tire Commonwealth of Massachusetts <br /> BARNSTABLE ss .�• DATE �Q.VI . -6 201 s <br /> Personally appeared before me the above-named I V%ko-y"-94 eland made oath that the foregoing statement is true. <br /> A certificate issued in accordance w section shall be in force nd effect for r years from the date of issue and shall be renewed each <br /> four years thereafter so long as su h bugincA shat c conducted and shall lapse and be voi less so renewed. . <br /> �ed <br /> Deborah Darr <br /> NOTARY PUBLIC <br /> chusetts Notar <br /> SEAL Commonwealth oil Massay Public <br /> My Commission Expires July 29,2016 <br /> Commission Expires: <br />