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BUSINESS CERTIFICATE # l <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE � /�J � <br /> • DATE / �/ <br /> Expiration Date: `-1/30/`l 9 <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: 110CI1L Wror A pilard Corporation Name: R2 r <br /> cv <br /> is conducted at Business Location: 0en4ra l ,Saowc_ Commercial L7 Residential_ <br /> Business Mailing Address: CPn¢r41`Sa Uarif <br /> Business Type: 0: 61 QPOQrc l Business Telephone: 60?) 9) 79 X//3 ;7 <br /> New Renewal ] Home Phone: . �7C�� yo�C7 yC17✓ <br /> Email Address: ml ICtr a( afernat� oCCI K2_ <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> 1�iI rh 3 it) Co3T <br /> t f2. nt (�s� r fJc� fUrn l nnduJ ICA <br /> Second Owner Name Second Owner Address <br /> Oilly, under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxesAs required <br /> under <br /> WY4 s1.2 g5_10 <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: 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 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 Massachusetts <br /> BARNSTABLE ss / 1 1 �p� j DATE <br /> Personally appeared before me the above-named (� /wu 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 four years from the date of issue and shall be renewed each <br /> four years thereafter so long assssuch <br /> �business shall be conducted and shall lapse and be void unless so renewed.. / <br /> :/JY <br /> Notary Public <br /> SEAL Y A. LEWISr� ^ �t <br /> Publ� L off <br /> &rRilluomm"emill <br /> OP Y�8a11p1UBET$i Commission Expires: <br /> ission Expires 25. 2021 <br />