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13USINESS CERTIFICATE N -2-C) II '008 <br /> • ti <br /> THF_ COilfiiIOtVFIBALTIIOFivIASSACIIUSE7'7S P J <br /> TOWN OF MASIIPEE <br /> DATE <br /> • Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declare(s) that a business under the title of <br /> Business Name/I)BA4'-WM*Wp� Corporation Name: is conducted at <br /> Business Location: <br /> Business Mailing Address: % <br /> Business Type: '.?J 4 Business Telephone: DI I ' 4,447/�. <br /> Home Phonet7GY/ 7� 3 Email Address: d(/lam/l l+l�Jl)— dt�. T <br /> by the following named persons: <br /> Owner Name Owner Residence, / <br /> I certify 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 /> taxe s reqs red tin law. <br /> G�-�-�• x X u - xX -olv ep& <br /> •'n a of a thorized agent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license gill not be issued unless this certification is signed by applicant <br /> In case of ernergeney <br /> NtANIE: TELEPHONE t i IBER: <br /> Alarm Company: <br /> "four 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 Massachusetts General Law,Chapter 62C, Section 49A. <br /> I <br /> The Commonwealth ojtllassachusetrs <br /> BAWNSTABLE ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing statement is <br /> 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 <br /> each four,years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> SEAL Notary Public <br /> • <br /> Commission Expires: <br />