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BUSINESS CERTIFICATE,2.0 <br /> • TOWN OF MASHPEE <br /> Date: (S <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as <br /> amended,the undersigned hereby declare(s)that a business under the title of r L 2 _+ <br /> Corporation Name: ((' (( tBusinesssss Name/DBA: `"f ' <br /> is conducted at Business Location::,�CV —YQI i�1nA+t � P-- ��D _ <br /> Business Type: r_''-�''Y` �S �sl'I,�C]t � <br /> New [ ] Renewal [ ] --Commercial [ ] s iic 'al [ ] Emaii res (�A <br /> Business Mailing Address: aS "`a- <br /> Business Telephone: .l�t� d�lo� '& Home [ ]Cell P hone: <br /> by the following named persons: <br /> Owner Name Owner Residence <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 <br /> alutraptaxes as rgQuirednd� er law. <br /> `Signature of authorized agent `*Social Security Number(Voluntary) <br /> -This license will not be Issued unless this certification is signed by applicant or Federa I Identification Number <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 <br /> filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or <br /> revocation. This request 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 It ll and made oath that the foregoing <br /> statement is true. <br /> �A;�'ecesrtificate issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be <br /> ( <br /> renewed C \r \ thRer so long as such business shall be conducted and shall lapse and be void I s so renewed. <br /> Signed g <br /> Si �/,��. Notary Public <br /> z� rt <br /> J09l;pppIn9Vf>f>�lRiW9C��J J <br /> NOTARY PUBLIC <br /> COAWMEALTH OF Yx5SACHUSERS <br /> My Comm.Expires Oct.16,2020 <br />