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BUSLNESS CERTIFICATE#In� <br /> THE COMMONWEALTH OF MASSACHUSETTS \ JL <br /> • TOWN OF MASHPEE <br /> DATE 1911a, 6 20/0 <br /> Expiration Date: I3 / <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 /> To.S '�l C'/uFTTF DBA Z�lT",6 5 %x7001-7 .t dOis conducted at <br /> Business Location: 27 4.0,Q7_", !S L03NS r /%A Si/J�fiL n/fJ. 0261/7 . <br /> Business Mailing Address: 2 G U4T6/2S L/a (//� T M/a S�ll���` M� 0 26 9 q <br /> Business Type: 0-12N5,61L7-YA16- Business Telephone: 50 53 1/ <br /> Home Phone: .'7-679 `/ 77- 5-0 S� <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> tT05"* Lr0//4 <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 /> es as required under law. ' <br /> *Signe ate of authoriz agent *Signature of authorized agent <br /> x 367-/,a - 90.5,4/- <br /> "`°Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: 5047 S ' 5-0 95_ <br /> Alarm Company: <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 he subject to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Coamtoetveallh of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing statement is <br /> 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 <br /> each four y�2� <br /> long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> igned <br /> Notary Public <br /> SEAL <br /> Commission Expires: <br />