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BUSINESS CERTIFICATE# <br /> r <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE (Ylol\/ y�, <br /> Expiration Date: Mqy 3 Z l9 <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: �r•� 5r- 7'� /`-"9 -t� I Corporation Name: �� -Q-✓�nG <br /> is conducted at Business Location': 7y� 2 t� ��'y"`�— Commercial Residential_ <br /> Business Mailing Address: ,�/_ <br /> Business Type: � �/ Business Telephone: 77- .2 <br /> r� <br /> New Renewal [.� Home Phone: <br /> S��s - y;7-7 y9y7-- <br /> Email Address: /' r-�5 r xe7' - <br /> by the following named persons: <br /> Owner Name Owner Residence <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 required <br /> Signature of authorized 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: P /Yl./ : tZt %P "� Telephone Number: -7-76 -00// <br /> Alarm Company: Zrl7Le;-Cl i914rn,5 <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 he subicct 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 Massach"setna <br /> BARNSTABLE ss /- JJ DATE`-a�o�i �/ ' <br /> > appeared U& Ct / Foregoing <br /> Personal) �a eared before me the above-named �I /��'h •B✓ and made oath that the foregoin 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 renewed each <br /> four years therea r so long as su u in N-hoc\oJnducted and shall lapse and be void unless so renewed. <br /> Signed0 <br /> t V Y Uic-C.LGct/` L <br /> ic Attary Public <br /> ntos <br /> Km= <br /> sachusetts Q - a-Set.22,2017 Commission Expires: <br />