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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <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 /> Business Name/DBA: 13 SAW) P�&(pora 'on Name: is conducted at <br /> Business Location: SQLV,44 & d G <br /> Business Mailing Address: 5a vii-e <br /> Y C v <br /> Business Type: A05rr�� BusinessTelephone: <br /> Home Phone: Email Address: 1es1,L NCA+44,2.i �(M'\ <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Les l o P I mem U� a(O SG y1J.4;J PCM J At <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 /> taxe as required�^der law. <br /> ."Signature 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: 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 suspension or revpeation. This <br /> request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br />! BARNSTABLE ss DATE <br /> Personal) appeared before me the above-named `PS �' e i fr,e#1(rd NnhNtiz j <br /> Personally ppe tY g5nd made oath that the foregoing statement <br /> is 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 fn y rs t ereafte long as suc t b iness ' all be condu ed and shall lapse and be void unless so renewed. <br /> Signed <br /> 1 I t CL G� <br /> Notary Public <br /> �; - Notary Public �I � a J- aG 1� <br /> "�a�A;;y,�t l„}lrfigrgi C S:7P'ot Commission Expires: <br /> 'k`\cfVB� `:OM.m�^.nerit^^t:'hSSS cr::159!!5 <br /> hj kr;Crs a ssiar. y.F:i es on Sep. 2P,?0!7 <br /> f' <br />