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BUSINESS CERTIFICATE H 7N <br /> ~ THE COMMONWEALTH OFMASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE l <br /> Expiration Date: 3 1 0Po l l <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: U-L1Stan AbSS PLSfi Ca7W Corporation Name: <br /> is conducted at Business Location: Sq Qu =hnej IZd NIGi Eke— A#OZ6Y9 Commercial_ Residential / <br /> Business Mailing Address: QilX sVnfel N] <br /> �t RGl:ahlCC. _- lT 0?64g <br /> Business Type: ]7eS eCll1�7 PI� Business Telephone: �� <br /> New [ Renewal [ ] Home Phone: <br /> Email Address: KUA �Ar�Y107PZI (OYv) <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> )(Ora Jean Fox[ k vt auashfo M Aftg, ge n l_j <br /> Second Owner Name Second Owner Address <br /> Oertify 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/Jas required under law. <br /> *Signature of Athorized 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: J rf.IPP rl �JU 'I Telephone Number: S 09-'Z7 L] SrOC4, <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 subiect 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 MassIachusetts <br /> BARNSTABLE ss <br /> Personally appeared before me the above-named hrn egan FiCotir r;n FLVn 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 ur years from the date of issue and shall be renewed each four <br /> years thereafter so long aasss such business shall be conducted and shall lapse and be void unless so renewed. <br /> •ed tbA <br /> licnotary Public <br /> SEALRM <br /> antos _ a *_�y>ssachCommission Ex ires: <br /> n Sept 22, I <br /> p <br />