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BUSINESS CERTIFICATE#:9&0 ^c)q„3 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE DATE —7e 2 7 a U J G <br /> - <br /> Expiration Date: 3 i <br /> In conformity with the provisions of Chapter one hundred and len, Section five of the General Laws, as amended, the <br /> undersigned hereby declare(s)that a business under the title of <br /> /J f�'7� /'t4/7 v DBA n e �j{L, n M'Ih� conducted at <br /> Business Location: /��' 1 �,C.�., <br /> Business Mailing Address: L Ay--e �� OD , //;1A— <br /> Business Type: p A <br /> SW e5 7(9 Business Telephone: T� �7 ZS <br /> Home Phone: <br /> by the following named persons: <br /> FULL NAME 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 /> taxes as required under law. <br /> *Signature o�rized agent *Signature of authorized agent <br /> '�2 -4- - Z-5-J y`(?2 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> ��v"� y��(���J� In case of emergency <br /> NAME: ` Q °t ' v� lJ '"� TELEPHONE NUMBER: <br /> Alarm Company: /07— <br /> *This license will not be issued unless this certification is signed by applicant <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 subiect to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing statement is <br /> we. <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 /> • Notary Public <br /> SEAL <br /> Commission Expires: <br />