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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE d <br /> DATE <br /> • Expiration Date: - 1/��/�C( <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: 1r /4-afx /"tit y Corporation Name: <Je p�A,Xc <br /> is conducted at Business Location: // q/t/Ofd'L 6�, Commercial_ Residential_ <br /> Business Mailing Address: <br /> /� P, / / q mcS.Yf e ..- (0A- <br /> Business <br /> (0A- �1 <br /> Business Type: FJ-: / Business Telephone: <br /> New V-1 Renewal Home Phone: . <br /> Email Address: /nALIAnn�® CCDM <br /> by the following named persons: <br /> M Owner Name Owner <br /> Residence / <br /> I—A✓v/) S(( /.ttigI�aSJQ'cn'( ma-�h4R -e <br /> Second Owner Name Second Owner Address <br /> Itify 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 /> s as required under law. <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 lax <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 Common weaUh of Massachusetts <br /> BARNSTABLE ss A �l ^fin DATE <br /> W �J <br /> Personally appeared before me the above-named FUA �' l7RANnJ 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 therea'ter so long as such busine shall be conducted and shall lapse and be void unless so renewed. <br /> •Signed ' <br /> Deborah Dam' NotaPublic <br /> SEAL "y� NOTARY PUB►-chusetts <br /> 1Vt�� Cotntnontlealth 01"Say 29 2016 <br /> MycotntnissionF�W Commission Expires: <br />