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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE AI �nn Z I D01 `5 <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 k <br /> Business Name/DB`A �S�IJc Y�1�J4 orporation Name: <br /> is conducted at Business Locationf:�c2 2eGY1LOGL�1 Commercial_ Residential <br /> Business Mailing Ad elIss: &L}p / <br /> Business Type: IQS 1""yI Y�_ \ Business Telephone: <br /> NewV] Renewal [ ] Home.Phone: 87 :53"!hone: H 07 <br /> Email Address: 1\)� 6't� mou GO <br /> by the following named persons: <br /> Owner Na a Owner Residence <br /> Second Owner Name U liecond Owner Address <br /> Sertify under the penalties of perjury that I!o the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as required under law. <br /> Oy8 -7O 70 %4 <br /> *Signature of authorized agen **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 l <br /> Name: O Telephone Number: So Oa ` �� <br /> Alarm Company: <br /> p Y: <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 Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE �7 <br /> r <br /> Personally appeared before me the above-named and made oath that the foregoing statement is true. <br /> A certificate issued in accordance with this section shall be in.force and effect for fopr years from the date of issue and shall be renewed each four <br /> years thereafter so long ass usiness sha a conducted and shall lapse and bemTd unless so renewed. <br /> ed <br /> 0 <br /> SEAL <br /> Deborah Dam Notary Public <br /> ° NO7ARY PUBLIC <br /> commonwealth of Massachusetts Commission Expires: <br /> My commission Expiies July 29,20'6 <br />