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BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE <br /> Date: <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as <br /> amended,the undersigned hereby declare(s)that a business under the title of <br /> Corporation Name: q �pp � Business <br /> �Nlame/DBA:WC\T_ c?, <br /> is conducted at Business Location: <br /> Business Type: IL. J <br /> New[(] Renewal [ ]--Commercial [ ] Residential [ ] Email Address: birr-K,.2Ism Ad(.ec� 5mgi/ <br /> Business Mailing Address: S (V �P&� t MP 0-_�U'�Qt <br /> Business Telephone: 11�"a3�o� ` O Home[ ] Cell [ ] Phone: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> 2Q mnjN 6� <br /> I certify unde the penalties of perjury that I,to the best of my knowledge and belief,have Sled all state tax returns and paid <br /> all state taxes s required under law: <br /> (3 (_0 <br /> 'Signatu a of authorized agent "Social Security Number(Voluntary) <br /> 'This license will not be Issued unless this certification is signed by applicant or Federal Identification Number <br /> In case of emergency -'Z% <br /> NAME:as' Qamft) TELEPHONE NUMBER: (oAla ]�] <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 sublect to license susoenslon or <br /> revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth ojMassachusetts <br /> BARNSTABLE, ss � <br /> DATE `5 \2q\1 <br /> / <br /> Personally appeared before me the above-named l� %Fr% f')'T and made oath that the foregoing <br /> statement is true. <br /> A certificate slued in acwr_dance with this section shall be in force and effect for four rs from the date of issue and shall be <br /> renewed each four ye therea o long as such business shall be conducted and shall lapse and a void unless so rene e <br /> Signed Notary Public <br /> Deborah Daf4Wnmission Expires <br /> '{ } NOTARY PUBLIC <br /> VR Commonwealth of Massachusetts <br /> My Commission Expires July 29,2016 <br /> i <br />