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BUSINESS CERTIFICA'T'E# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE ,/� <br /> DATE C./J.�X i 3 I I <br /> Expiration Date: <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 /> Business Name/DBA: The 14e.se Corporation Name:• is conducted at <br /> Business Location: 54 A) 101 t7 S, L�) Uzi; '11 144c�Oee141111 9,20f <br /> Business Mailing Address: 56 �) 'r �6 {'{0 ,(.,,, )L I > /�aShr^off /r'I/ a2`y!✓ <br /> BusinessType: lIsA.: &&"Cir 12.+6c.:✓ Business Telephone: 5o6' 360 toS`( <br /> t <br /> Home Phone: 56t 366 16 Sq Email Address: CI V. aSJro: P �,�.Leo •�o,.,,, <br /> by the following named persons: <br /> Owner Name Owner Residence a <br /> A(,c¢/o a..., , 917 SanAa, r L. �01 <br /> S!C , &e 511 <br /> 1 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 required under law. <br /> y5- I Z7IS-77 <br /> •Signature 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 susnension or revocation. This <br /> request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Cmnnrontveulth of Massachusetts n <br /> BARNSTABLE ss DATL' O f <br /> personally appeared before me the above-nantcd \>.Jtaa and made oath that the foregoing statement <br /> i IS 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 thereft <br /> a^er so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> h /.. <br /> i Signed /(Y��� <br /> I ���..•/// otary Public <br /> SEAL <br /> Notar. Public Commission Expires: <br /> Margaret <br /> C.Santos <br /> ComMwlitve0 of Massachasetk <br /> M Commiesfun Ell fres on S%.22 2017 <br />