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Pi Ci <br /> BUSINESS CERTIFICATE# '2016'0 <br /> '4 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE �I l <br /> DATE <br /> Expiration Date: 3 3 f R-b <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 /> GICLP I nG ^� n ' { DBA ` 9:t p _#_ZZ39 is conducted at <br /> Business Location: �� n��, Nom+ 1 GpI�I(I�S ,1U {� I�'l1ci�s hpee rn <br /> Business Mailings And-{dr�e�s�s: o ( F Q-7 U"I 'f"l�l ,r I ✓L ISL-IJ� <br /> Business Type�I j��,"�"`^/'i-I Business Telephone: — Ll`f � ^ Le L' 4.'r <br /> Home Phone: 5o `C(.pZ �3Z <br /> by the following named persons: <br /> FULL NAMERE ENCE <br /> C-, lorl a t i_e is tm 40 �-t KKK n v/ <br /> Ihu.qt) nm 159ic?_ <br /> I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes require d under law. <br /> *Signature of authorized agent *Signature of authorized agent <br /> 41-1- I lvq'1 Z3 I <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> I (� r� In case of emergency C�(� n <br /> NAME.Ie—SS I CU q k— TELEPHONE NUMBER: d` 1S —�3 l � <br /> Alarm Company: 6bir <br /> *This license will not be issued unless this certification is signed by applicant <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 subject to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> BARNSTABLE ss DATE <br /> The Commonwealth of Massachusetts l(l I MO <br /> Personally appeared before me the above-named G I era nelson <br /> I eI SD'n 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 4'aak p 11'I <br /> • C,/X ! MA_� ✓t /� <br /> KJj <br /> SEAL OFFICIAL SEAL Notary Public <br /> � <br /> Marie McKenney <br /> ' r Nota PublicCommission Expires: <br /> Stets New Mexico <br /> tm <br /> My Cmnlsflon Expbes <br />