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BUSINESS CERTIFICATE# _ <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE nn <br /> DATE R a <br /> • Expiration Date: '31 o l <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/DBA: MASNd2 Pr MA2T Corporation Name: (''A0) & 1't3A p0AA+fb n is conducted at <br /> Business Location: fes/ -trAL j-1oD+6 RD MA�tpr� MA 0)-") 9 <br /> Business Mailing Address: 4q GALA0()T& 2�� MA$ /�' L� fJ)-A!d <br /> Business Type: Business Telephone: <br /> Home Phone: S�O Email Address: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> CHAkct-J_ M r=A&hn& !�LX Q0 rl-13 MASH,y /'_ <br /> MA n2-614 � <br /> I certify 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 /> taxes as required under law. <br /> t <br /> �2g-8o-07110 <br /> attu'e of authorized agent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency % L <br /> NAME: qYA /<r_GL M FAR�OB TELEPHONE NUMBER:�O$^�L6=f�339_ <br /> Alarm Company: W9 S/n 1q) <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 Massachusetts General Law,Chapter 62C, Section 49A. <br /> The Commonwealth nfMnssnc•/utserrs e�� <br /> BARNSTABLE ss DAT 60[O <br /> Personally appeared before me the above-named _qr7Akl3&L M FA RO D(9 and made oath that the fo going statement is <br /> T <br /> true. i <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 thereaftersolong as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed 1. a eV\ <br /> /�� Notary Publi <br /> is <br /> SEAL Deborah Daft <br /> NOTARYPUSUC Commission Expires: <br /> commonwalth of <br /> My ComE*ms July 29,2016 <br />