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BUSINESS CERTIFICATE# 10- 023 <br /> THE COMMONWEALTH OF NIASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 26 10 <br /> Fxniratinn hate- DPCPlnhP.Y 3l, 2/ll4 <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 /> 13. Lynnc G ru / e— 0.u DBA v, s h I°t t 3i r� ��� is conducted at <br /> / t <br /> Business Location: I "A �t Yto u 1 k R l ( �1 t — I a u S k r <br /> Business D4ailing nAddress: <br /> te_r (frco5S ;^1.) U. eto-C ICV.{ <br /> Business Type: �) �o ✓1't e 4r. 5 Business Telephone: 9� �- y 7 7 — / V ;k, <br /> Home Phone: 8" y 2?'- 7 <br /> by the following named persons: <br /> FULL NAME RESIDENCE l t <br /> (j. Lynvtt Gro rc Q.�. 165 Lel tip'54le 190riy Or. <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 /> ees as required under law. <br /> *Signature of authorized agent *Signature of authorized agent <br /> 0+- as8g132, <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergent}' <br /> NAME: Se044- Sm In <br /> 5b 8 - 6t/8- 37 $ / <br /> TELEPHONE NUMBER: <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 lax 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 ofAlnssachuserfs <br /> Br\Rr\'STABLE ss p / DATE <br /> Personally appeared before me the above-named /7 /�y� lLl�J'/20 UP HP 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 thereaft so long as su sirr�s shall be conducted and shall lapse and be void unless so renewed. <br /> Signed E I <br /> • e Not <br /> SEAL COMMONWEAL OF MASWICHUMM <br /> My Commission <br />