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' BUSINESS CERTIFICATE# 39 <br /> THE COMMONWEALTH OF MA SSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE / Y LCt,I, 1 O?tJ <br /> • Expiration Date: az 020 <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: �'6/y /Corporation Name: <br /> is conducted at Business Location: 14f (q--A/1 PL rg Commercial-1ZResidential_ <br /> Business Mailing Address: h f Y!�Z( 'd//rcc�76C6O <br /> Business Type: /lL�( t %�l�/!Q/�. Business Telephone: 224. ZZO - <br /> New [v J Renewal [ ] �� Home Phone: <br /> Email Address: u - • W �t <br /> by the following named persons: <br /> / Owner Name Owner Resident <br /> Second Owner Name Second Owner Address <br /> ertify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as requir9d under <br /> 'Signature f prize 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 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 BARNSTABLE ss /� I ��/ (� DATE <br /> Personally appeare before me the above-named Y�nhe, 1, 4o,-",and and made oath that the foregoi statement is true. <br /> A certificate issu in accordance with this section shall be in forcefind effect for four years f om the date of issue and shall be renewed each four <br /> years thereafter s such business shall be conducted and shall lapse and be void unless so renewed. <br /> �ed <br /> C <br /> - otaryPublic <br /> SEAL <br /> Commission Expires: <br />