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BUSINESS CERTIFICATE # :2-011 — O 't <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE ( <br /> . Expiration Date: 37 2-V <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: Corporation Name: is conducted at <br /> Business Location: <br /> Business Mailing Address: <br /> Business Type: Business Telephone: <br /> Home Phone: Email Address: <br /> by the following named persons: <br /> Owner Name Owner Residence <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 /> *Thi3 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 tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license susuension 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 /> 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 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 /> SC-AL <br /> Commission Expires: <br />