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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE 1-7 3 N Pq 1 I <br /> DATE <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 /> ii Business Name/DBA: " j6 Y&2f Ie,0� Corporation Name: is conducted at <br /> Business Location: <br /> Business Mailing Address: <br /> Business Type;/ MI( u 'I/Y�Jt�I Business Telephone: x7,016) -717­1 <br /> 1% _7�(o <br /> Home Phone: Email Address: <br /> by the following named persons: <br /> Owryef Name 1 Owner Residence <br /> �,7 h1.1-��or,�l�reef4—?>2 <br /> I certify under the penalties per'ury that 11 to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> tax eq 'red u der <br /> 44g� 'O/J' �/(p <br /> MW ature of authorized e . "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> "This license will not be issued unless this certification is signed by applicant <br /> ,1 /J In case of emergency / <br /> NAME: ITELEPHONE NUMBER: (�60)��:5_&&0l <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 he subiecl to license suspension or revocation. This <br /> request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. _ <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ssDATE 3 <br /> Personally appeared before me the above-named f*rj(-d-L- A kAAN-e4, and made oath that the foregoing statement <br /> is true. <br /> A certificate issuedi <br /> naccordance with this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each foung�s such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> ary Public <br /> • SEAL <br /> JOSEPEbtndNf6&tf�Q�_ �Jp <br /> Notary Public <br /> OOMMONWEAITM OF MA89i1G7�Ng}}� <br /> WCarnmmion . <br /> OUoaaZi.'p013 <br />