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J <br /> • BUSINESS CERTIFICATE# <br /> i <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> - DATE <br /> Expiration Date: I lJ <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: LJ(?t")16E I S hG/t C) Corporation Name: /a,/ ZSki <br /> is conducted at Business Location: �q6'a'0-)/17/ r�l�. Commercial_Residential_z <br /> Business Mailing Address: // 6 m1;1/ /C- /� <br /> Business Type: G1l� P 71i/J Business Telephone: 5()8 <br /> Business Phone-50 (OHome Phone: Email Address:19h h eCY'"CIiS�` <br /> ­7 �� 3�j,305 3 Jmet <br /> by the following named persons: <br /> Q Owner Name Owner Residence <br /> 11l2 r4 of L� 42 <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 /> taxes as required under law. <br /> o/�3 -sv -1;"90 <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 /> NAME: ( GL 7 I��/ ly 6/a ll-) TELEPHONE NUMBER: 97P 2 <br /> Alarm Company: �J U <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 of Massachusetts <br /> BARNSTABLE ss �I DATE <br /> Personally appeared before me the above-named 6nQ'o I / /P and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in.accordance with this section shall be in force and dredt for four years from the date of issue and shall be renewed <br /> each four years thereafter so long as,,suu�cchhj business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed �/�7. ✓ii�'�GGt/lh <br /> � a I <br /> • Notary Public <br /> SEAL <br /> Deborah Dam' <br /> NOTARY PUBLIC Commission Expires: <br /> Cotntnat WUO 01 Ma jilty c uS 018 <br /> My COnIM Won EYOM <br />