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BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE t <br /> • Date: Ll. z 7./� <br /> Expiration Date: f /w/I� <br /> In conformity with the provisions of Chapter 110, §5 of the Massachusetts General Laws, as amended, the <br /> undersigned hereby declare(s) that a business under the title of <br /> Business Name/DBA: RHO - jO <br /> ARr, �J� ,_Corporation Name: <br /> is conducted at Business Location: 35-J6ft prW.. 1'"InQS6jkg Certificate No. <br /> Business Type: Ar f <br /> Mao ozro�l9 <br /> New [II/Renewal [ ] Commercial [] Residential [ ] Email Address <br /> 1j <br /> Business Mailing Address: dkore br. (E Pt�;, MQs_ hpea MA021AQ _ <br /> Business Telephone: Home ell [ ] Phone: .509,K77. Z✓5�f <br /> by the following named persons: <br /> Owner Name t Owner Residence <br /> Rnrze bhoryne. U 35 S Kort. Dr. Wes� <br /> i_�blQ2i�LG 6bmwL Ma.shpee . MA OZto�f9 <br /> 11W Icertify under the penalties of perjury 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 /> MOMIL4U R►2. /PL/. 8 ql <br /> *Signatu re�rized agent **Social Security Number <br /> *This license will not be issued unless this certification is signed by applicant or Federal Identification <br /> Number(Required) <br /> In case of emergency <br /> NAME: �lCJI►nfi cel, C J Y1/hi QQ TELEPHONE NUMBER: 791 - 379, 1515 <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 Chapter 62C,§49A Massachusetts General Laws <br /> The Commomvenhh of Massachusetts <br /> BARNSTABLE: ss DATE (Zor, <br /> Personally appeared before me the above-named PCCG Q Dint2e (► 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 years from the date of issue and shall be <br /> mewed each four years thereafter so long as suchbusinessshall be conducted and shall lapse and be void unless so renewe . <br /> Signed w,C.u��, Ob ,— . Notary PublicA AAA <br /> Z Notary Public Commission Expires - a 'X067 <br /> Margaret C. Santos <br /> ,"ommomyealth of Massachusetts <br /> Sky Commission Ez fires on Se t.22,2017 <br />