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BUSINESS CERTIFICATE# 20f <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF AWHPEE <br /> DATE <br /> Expiration Date: A <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 /> (�LogAL L7aP+�.SI�r'UES LvGRS -% �fii�KE <br /> Staginess Name1DBA: ! . -'` 51ou..r= Cor don Name: �l off` s✓ P '�' � is conducted at <br /> Business Location: l03 �. +d• s t r ;�� Qom- J-+�- s1.��,i , e��c v r+�t <br /> Business Mailing Address: Po ZolC 8 t`� w• �� i S P-1 Jr M A O 2to 72 <br /> Business Type-/ A�r:..a... E.....�� Sass;�a S Business Telephtnte:(77`l> " `{9 — tis c b <br /> Home Phone: C7 7 4 l2Q{p Email Address: l�cs�s�t�� ems. ,cyst - *•a—� <br /> by the following named persons: <br /> Owner Name Owner Residence ` <br /> S-%Q— Petr Qr;Gaoe 35- <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 requited and a <br /> �Sigoature­ofauthorized agent **Social Security Number(Voluntary) <br /> • or Federal Identification Number <br /> wilds license will not be issued tmiess this cert)fcation 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 subiect to license summoslon or revocationthis <br /> request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A <br /> The Commonwealth of Massaohusetrs <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named j) /l S Y om--and trade oath that the foregoing statement <br /> is nue. <br /> A certificate issued in accordance with this section shall be in force and effect for fav years from the date of issue and shall be renewed <br /> each four years thereafter so long ucb business shall be conducted and shall lapse and be void unless so renewed. <br /> Si,,,,,��,������/ <br /> �/ <br /> Notary Public <br /> SEAL <br /> • <br /> Commission Expires: <br /> cOwuv.�� .YaE <br /> MY . e <br /> r <br />