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ri <br /> BUSINESS CERTIFICATE#Te' (7-/ OQ <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> i <br /> Expiration Date: !#'3, oW < <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> indersigned hereby declare(s)that a business under the title of �L <br /> DBA T/�/l / is conducted at <br /> Business Location: 17 �:y // /f1/jocG^� / ��/� <br /> Business Mailing Add r11cjjs: //lc //6./` I. /� Lo env✓/ fY�u�7q //-/,s/JU>�J�r/ter.> 4hh//-�, , ,02-4 J <br /> Business Type: //px/C�71/,J�} Business Telephone: J o�s- /"�O ' <br /> Phone: 7D17y�- MZ <br /> by the following named persons: <br /> FULL NAME RESIDENCE <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 as re qu' (!under law. <br /> 'Signature beauthorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency �— <br /> NAME: //�..OL v /3a111L /�- TELEPHONE NUMBER: 'O� <br /> Alarm Company:SIMw Je�T <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 he subiect to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Cornamurvealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-na, and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section sh ll 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 conductN,and shall lapse and be void unless so renewed. <br /> igned <br /> ((11 p��(\JRAeaL� <br /> Notary Public <br /> SEAL S,A�� <br /> l�l�5aC/t,UX-f FCommission Expires: <br />