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• ,� BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASfIPEE �l <br /> DATE <br /> Expiration Date: 3 / '--J <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) t/hat a business under the title of <br /> Business Name/DBA:J�r, [49�eApe &&r Corporation Name: is conducted at <br /> Business Location: %gAer/rt—,-, k G Ln,� �y/q' <br /> Business Mailing Address: 36 U"e///•rGv i NA Le 1-41l e- /�/�7��0'Cr�, �// � ��s /j"5' <br /> Business'1',ype: �fCT C 44td101Wia/r Business Telephone:(Sa �� Sal <br /> HomePhune: ,�SOSS ) --S,197`r L Email Address: ��ir»PS SNn�%C 4.,a�✓Il f//�f{aa, �`Q7^ <br /> by the following named persons: <br /> Owner Name Owner Residence / <br /> 2'P /72 r. 4. ;n k (e 4�1 <br /> ^ �-j1f1-e-e 4 /1- 0 Z 7 <br /> I certify under the p naltiesof perjury that 1, to the best of my knowledge and belief, have filed Sill state tax returns and paid all state <br /> -t as required un er law. <br /> *Si iamre of authorized agent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *'Phis license will not be issued unless this certification is signed by applicant <br /> In case of emergency (/'O L F'��,/a <br /> NAME: "'�/7�/ L 344/?iC'7hc/'b TELEPHONE NUMBER` /' p�l y /O <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 susnension or revocation. This <br /> request is made under the authority of Massachusetts General Lmv,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts 3 <br /> -BARNSTABLE ss DATE <br /> I � C <br /> Personally appeared before me the above-named: aHr,s l NIC- d0 PAd and made oath that the foregoing statement <br /> is true. <br /> A certificate issued in accordance with this sectJ, it shall be in force and effect for four years from the date of issue and shall be renewed <br /> each fo yc rs thereafter o long as such business shall ( nducted and shall lapse and be void unless so renewed. <br /> Signed = <br /> Notary Public <br /> SEAL <br /> • <br /> JUSEPM L. <br /> NoEOF <br /> COMMONWEALTH <br /> MycaON <br /> TIi <br />