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0 73 <br /> I;uslnh-ss ctlrrn�lcA rr�i o� <br /> THE COmmAIIOnrll1e1u,7'11 Or nIIIss ACHUYE 7s <br /> TON'NOFAL9SIr[PL''H -----V DATF- <br /> Expiration Dale: Decelinher 31, 2073 <br /> In conformity with the provjsions of Chapter one hundred and len, Seclion live of the General Lays, as amended, the <br /> undei:siguecl hereby declare(s) Lull a business under the title of <br /> J0 J 15C/� _ DBA_ LA 0(/q4y q��� c 4t62� is conducted al <br /> BuSmesS LOCanDlll—t- 44 A <br /> Business Mailing Adddics's /sr��r ��,�,, �-�G� �'��,� <br /> Business Type: L�./`l' Business Telephone: _� 539�0? <br /> by the following named persons: <br /> FULL NAME Pi. �rNCIE <br /> rn <br /> Home Phone: 5(/d S-31-02S-1( <br /> I certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all stale tax returns and paid all state <br /> tax required under law. <br /> 4w— <br /> m� � s s� csC'as <br /> * tgna[ure of authorized agent email address V W, <br /> "*Social Secunty Number <br /> of Federal Identification Number <br /> Ll case of emergency <br /> NAME: X-41- l( -L�azt�2 TELEPHONE NUMBER:, <br /> Alarm Company: <br /> **your social secwity number will be furnished to the Nlassachusetts Department of Revenue to determine whether you have met tax Gling or tax <br /> payment obligations. Licensees who fail to correct their non-filing of delioquency will he subject to license suspension to revocntiou. This request <br /> is"made"uiidec.the.authoi ity,of NIas-sacllusolls.Cenelal Law.,Chapter 62C.S.ectiop ___.__ <br /> The Commonwealth of Alassuchu.sefts <br /> BAI21s'STABLE ss DATE7/6 <br /> Personally appealed before me the above-named t_(_ L4 1 k2/LA and made oath that the foregoing statement is <br /> �— <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 /> -- -- <br /> ua& four years Ihereafiei+sno/long as sucnn6Gusines)sqJ-3lialQf6/Jc c�iicted an i shall-lapse and be void <br /> 1119 - <br /> Signed <br /> • I tNotary Public <br /> Sf_AL <br /> COMMONWEALTH OF MASSACHUSETTS <br /> 'o m m i ss i fklt�+lYB;@M3 . <br />