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BUSINESS CERTIFICATE ti <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE r <br /> DATE .� I'v3 1/2, <br /> Ir Expiration Date: .1 •� <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: r"41.0 wt r'"s Corporation Name: Et.O VV t rtS�LSS , (rt(. • is conducted at <br /> Business Location: (-1 NOrffn S{ M4ShPtG r MIS 0264-ri <br /> Business Mailing Address: `r1I0 \N l/YIGlAC KrKi A'f kS 4 Nt/ SrIII <br /> Business Type: P-cf?'VI Business Telephone: <br /> Home Phone: 101-VP7-(01,0-0 Email Address: r Rawl iLvt.QiG{o✓•/1r�l.�ii.C�'vt <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> !nlin q2ZOVV-9:G,jea� Ash-, LAI Ur:vi,MV` Ft12,1 <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 /> 33-04v0c) <br /> Signature of authorize 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 fumished 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 <br /> request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> Cou'hl of aArk_ T4 <br /> ssDATE . /(F, <br /> Personally appeared before me the above-named /TT�Z. L.-ly+*<-f -ice and made oath that the foregoing statement <br /> 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 thereafter so long as ch business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> U Notary Public <br /> SEAL <br /> r - /.� <br /> DAYLE K.PAULSONmission Expires: <br /> Notary Publlt>Stete d Nevada <br /> APPT.NO.6480761 <br /> My App.Epi,_August 28.2013 <br />