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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE DATE /3 //3 <br /> b 7 <br /> Expiration Date: 313 / <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: 6.000 U�/ f�FTE�iUOG+✓Corporation Name: is conducted at <br /> Business Location: 1.4AS#-PZ�� /✓lA <br /> Business Mailing Address: <br /> Business Type: 1)461614LACT' / BusinessTelephone: SDS' N77-/Osy <br /> Home Phone: SD� y�7 /0�7 Email Address: C/G2iS%tilC /✓IfFSCO%% V,E�00On-n6T r <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> L'fit2/S7n� /Y1r}SLOTT // /t��3GviS�/ Zf✓6�' <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 /> t� 0�?-7- loo -699/�7 <br />- igna[ure 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 /> i . <br /> **Your social security number will be fumished 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 subiect to license suspension or revocation. This <br /> request is made under the authority of Massachusetts General Law,Chapter 62C, Section 49A. <br /> The Commonwealth of Massachusetts BARNSTABLE ss /_ DATE 3- G •d4>l3 <br /> Personally appeared before me the above-named oh/•5 VII&AtS CC),It+ and 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 four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed �����i/% ^�/-� //-�•C <br /> Notary Public <br /> • NotetCPSantos n 9 a -ao l7 <br /> eiet .SantOa <br /> MargCommission Expires: <br /> -Gommomvealth d Massachusetts <br /> SKYICommission Expires on Sept.22.2017 <br />