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ia� <br /> BUSINESS CERTIFICATE#dOCY-v( <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF NIASHPEF. <br /> • DATE 15rr K m%CoL 14, L091 <br /> Expiration Date: December 31, .201 S <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 /> (1,\ C'/, WM—D_5,/S;A3 DBA MQ'31 I L4 5 GA A.CH F S is conducted at <br /> Business Location: (}q 10Ar6-L.r. V$ M4SI4eIEm Ma DZ-ofq <br /> i <br /> Business Mailing Address: -541N(6 <br /> Business Type:QactSorJ1Vr.L kites it Business Telephone: LG 17, O <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone: (502) f39 - "61 <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 /> t es a r quired ut er law. <br /> tttature of authorized agent *Signature of authorized agent <br /> 44 -3z - l8i '1 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> . In case of emergency <br /> NAME: 51'4A LAEy W 4-1�5-li:,A) TELEPHONE NUMBER: 40;? 10 2�e <br /> Alarm Company: U fks ID E <br /> *This license will not be issued unless this certification is signed by applicant <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 /> 13ARNSTABLE ss 1 DATE k7J <br /> Personally appeared before me the above-named�y\tAt���� V�. and made oath that the foregoing statement is <br /> 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 /> cact,.fuu ears the eaftcr so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signcci ss cl_\Q ^vim ../ \�V���' - _ �, `VICKI ANN GOVONI <br /> Notary Public <br /> Nq*C '�MAjj%ion EV res <br /> SFAL JWv 19.2013 <br /> Commission Expires: <br />