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BUSINESS CERTIFICATE #,) / O ^Da r <br /> THE COMMOMVEALTII OF MASSACHUSETTS <br /> TOIVN OF MASTIPEE <br /> • DATE <br /> Expiration Date: <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 /> Busiucss Name/DBA: clAgS�0%10. Corpora tioit Name: is conducted at <br /> Business Location: <}' 'J' 9 o'-T �Zp�l (/✓�. 51-lpV-C,rn(� pz�d� <br /> Business Mailing Address: 'T b9 N(NT HtAtQ r///S NW t UrtotT 6 F}S M� AAA 026-7 <br /> •Business Type: Business Telephone: <br /> Home Phone: Email Address: <br /> by the following named persons: <br /> `— O rner�«uu� Owner Residence <br /> � <br /> 77 Yy Co ✓}� <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 /> nature 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 <br /> NANIE: TELEPHONE NUNIBER: <br /> Alarm Company: <br /> I <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 Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Hassachusetts -7 <br /> BARNSTABLE ss DATE / /V <br /> Personally appeared before me the above-named and made oath that the foregoing statement is <br /> ave. <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�e � K Q <br /> • Notary Public <br /> SEAL <br /> q nom, JOS n .rr <br /> lana xH�Fi3. <br /> OOYYOt1WFJLLTH OF MAS&VWLqXM <br /> W 07tiiMIssim E piw <br /> • OcY00et73,X19 <br />