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BUSINESS CERTIFICATE 00 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE Q <br /> DATE <br /> Expiration Date: �' S <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 /> ��^^ ,,''t <br /> �) Business Name/DBA:,�M/TtYSe Q-re� lbrp/or�ation Name: is conducted at <br /> Business Location: 13t3 � (/�rl0U (h f�/0/4� � 19SH�EE �A <br /> Business Mailing Address: PF OR/P11) L <br /> Business Type: � e IR/L ^,./�Ge Business Telephone: <br /> Home Phone- Email Address: Sir S/G�C'R�4."<<e 40/' <br /> I <br /> by the following named persons: <br /> nOwner Name Owner Residence <br /> RIC �7R^R SmI I'�F ! bR�HI� L.0 'FIN 0') /k '4 <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 qui ed under 1 w. <br /> a36 3 6 <br /> •'`Signature of authori a 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 /> Q Q <br /> NAME: / 1 1 G P(�`2d.J sym I('t 1 TELEPHONE NUMBER: �d U 213 <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 subiecl to license suspension or revncalion. This <br /> request is made under the authority of Massachusetts General law,Chapter 62C,Section 49A <br /> The Commonwealth of Massachusetts �. <br /> BARNSPABLE ss \(^/ C / DATE <br /> Personally appeared before me the above-named `� t C-k OW-41,_ ✓iK t'ry� 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 such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed - <br /> Notary Public <br /> • SEAL JOS ?H FL.MgZI�CCNELLI,Jfi <br /> 1S}IN'EMt1ASSACHUSETTS <br /> MQ Pmyntssicn Emilia <br /> !S.`20U <br />