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C BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TO IVN OF MASHPEE DATE <br /> • Expiration Date: " O l <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 <br /> under the title of /� <br /> sutess Name/DBA: /6 L/�///, (—&!%a tions j'Name: — � � K`��j1 ff ri—ts conducted at <br /> �6usiness Location: �I / `tW "�` <br /> meq- a� <br /> Business Mailing Address: 401Na ( <br /> Business Type: usiness Telephon777eyyy ,,' <br /> Home Phone: Ag <br /> ,� �78 Email Address: 1 //� /!/1/ F/X/IOO CN <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> I <br /> Tian Wa rffzl X21 �l(asJ�9at wry <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 /> ature of authorized agent **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <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 /> BARNSTABLE ss DATE D <br /> Personally appeared before me the above-named M/.'I/ % 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 hong as suchbusinessshall be conducted and shall lapse and be void unless so renewed. <br /> maned t/�kk 1IWhb <br /> ( .IJV'/es . <br /> JOSEPH L. <br /> • SEAL. Notary Pubic <br /> G49AGll1iEni <br /> COY <br /> YY sioaEqirgepires: <br /> 0YIaWt.26.2013- <br />