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BUSINESS CERTIFICATE# 0L�oV <br /> ` THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE —�.5— <br /> • Expiration Date: <br /> In conformity with the provisions of Chapter 110, §5 ofthe Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title of <br /> Business Name/DBA: l'>a�ff OG_,�F &X-04-'SCorporation Name: __17 <br /> is conducted at Business Location: JW Commercial_ Residential <br /> Business Mailing Address: <br /> GyU/Lse`z�il/� Business Telephone: ' `� 7J Z 7 e--;:>Business Type: P . <br /> r <br /> New (�]/ Renewal Home Phone: . <br /> Email Address: ��UL %�L�'�1�OG��Gp,mG��"T. •y�`T <br /> by the following named persons: <br /> ® Owner Name Owner Residence <br /> /�Y�UG /37 /BGG �/ GGGri G/�iz�L` <br /> Second Owner Name Second Owner Address <br /> Ofy 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 /> taxesasrequired under law. <br /> r� �-�-u��c>✓r-� ,L-��r'�� O/Z — �i'�- .SAO G� <br /> *Signature o 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: -0—O00 <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 subject to license suspension or revocation. This request <br /> is made under the authority of Chapter 62C, §49A of Massachusetts General Laws. <br /> The Commonwealth ojMnssnchusel(s �1 <br /> BARNSTABLE ss DATE�I�a � "aa I <br /> "' and made oath that the foregoing Personally appeared before me the above-named U J\ g g statement is true. <br /> A certificate issued in accordance with this section shall be in force and dftct for four years from the date of issue and shall be renewed each <br /> four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Oecl ,� �� dASHPEE TOWN CLERK <br /> ` <br /> JAN 2 3 2015 <br /> � NOtBry'Public Not[ry Public <br /> Ftiao�arot G;Santos' <br /> omitonwttallhafMassachusldts R, CEIVED <br /> ��Mi mtlrissonE%pffesonSBlit.22,2017 Commission Expires: <br />