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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TO NIN OF MASHPEE /r <br /> DATEZe <br /> (� <br /> Expiration Date: <br /> j 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: `"n �►,\ Cm'poratimt Name: iJs conducted at <br /> Business Location: l�y tl� /-t (A 1 <br /> Business Mailing Address: VVVA_")/ID— n�c��19 y <br /> Business Type: Business Telephone: 5�D — y1. i l 44-C a ) <br /> Home Phone: Email Address: ,.NCCSYI'4rG+..CWk,. �, '�CU4 . <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Ileo� l ►u� A <br /> CA <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 required andIQV <br /> � . <br /> ys� �r�y <br /> T <br /> n'e of <br /> 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 /> l In case of emergency 7 J 7 <br /> NAME: \ llu�. 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 gill be subject to license susnension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts BARNS"I'Al1LE ss DATE Z �f <br /> Personally appeared before me the above-named and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section shall be in fort 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 conducted and shall lapse and be void unless so renes ped. <br /> Signed /j40 <br /> Notary Public <br /> • SEAL <br /> oil�s. � xpi c <br /> COWIM1NffALiN�'1OF MASIi�CMKETT <br /> tMYCamisabnF.t�'vtn <br /> =Am <br /> 20[�- <br />