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BUSINESS CERTIFICATE#o9-_O&,)— <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE �— <br /> DATE ut-, 1_(.n-r- . <br /> Expiration Date: DCC6I7ZIICY 31, 213 <br /> In confornuty with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declaie(s)that a business under the title of <br /> l sT/J /✓T' �ii�i >C _DBA eZf s conducted at <br /> Business Location:� �/ "�/C/� �g/,3J/"��/�/elJt'1/ //l�/�,.T�✓/'� <br /> Business Mailing Address: Ornl�z) Gees eIAOY/.11w ,/»�•�%r�/��' <br /> Business Type:'Iee il6� Business Telephone: �� ���� 3X5 <br /> by the following named persons: _�T <br /> FULL NAME RESIDENCE <br /> Home Phone: rj08 <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 /> .,a re onijtjl�oriae t _ *Signature of authorized agent <br /> *"Social Security Number(Voluntary) <br /> of Federal Identification Number <br /> In case of emergency �f <br /> NAME TELEPHONE <br /> TELEPHONE NUMBER: T��� 4Tca��3' <br /> Alarm Company: <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 Gencial Lav,,Chapter 62C,Section 49A. <br /> The Comtaanvealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named 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 /> each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> 10 Notary Public <br /> SEAL <br /> Commission Expires: <br />