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BUSINESS CERTIFICATE H O 1 I <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE ++ <br /> DATE l—G h 00 , aG 15 <br /> • Expiration Date: re-b fie, Do I q <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: 51442 0 L4arq'-0— ruo "P' -BLrporation Name: <br /> is conducted at Business Location: 32 Sa^t �v� l / V Y� Commercial_ Residential�� <br /> Business Mailing Address: S� <br /> � 112 .Soak- � 1 - a4 8� <br /> Business Type: Business Telephone: <br /> New ] ] Renewal ( ] Home Phone: <br /> al . <br /> Email Address: I ` <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> /-�-���� fit, 1��� � 2 sat?;��„ �► �an� 6z� . <br /> Second Owner Name Second Owner Address <br /> ify 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 /> s as required under law.g ` � � <br /> tgnature 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 famished 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 of Massachusetts <br /> BARNSTABLE ss IInn tt DATE ­e6 o70 o?G/ S' <br /> Personally appeared before me the above-named nK�k V Y k^X n i Cr h 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 thereaft r s ng as such business shall be con cted and shall lapse and be void unless so renewed., <br /> Signed A< ` <br /> =W <br /> t ":Notary Public otary Pubic <br /> SEAL Margaret e.Santos <br /> Commonwealth bf Massachusetts <br /> My Commission EXplres on Sept.90 2017 Commission Expires: <br />