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BUSINESS CERTIFICATE# X 11-67 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE oQ <br /> DATE <br /> Expiration Date: �I3v <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: ��511 Corporation Name: (� is conducted at p <br /> Business Location:1 <br /> a W.c� s An 1,i <br /> Busines �M;iling A�ress: �'�.� <br /> ,�Business Type: Business elephone: <br /> Home Phone: <br /> S — Email Address: a0 <br /> 4 <br /> lr�s p�o-to�c�q��,.y�3� yakuo.Cl>u1 <br /> by the following named persons: <br /> Owner Name Own r Residence s <br /> C`tie��o\ t�Ut (/ sti[o�� Z121 �32 <br /> I 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 /> Aw <br /> quired under la <br /> 63a 3g <br /> *Signature of th sized 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 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 /> BARN'S1'ABLE ss DATE <br /> Personally appeared before me the above-named r made oath that the foregoing statement <br /> is true. 1 <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 yea thereafter so long as such bt •iness shall be conducted and shall lapse and be void unless so renewed. <br /> Sig ed I X U0 ' <br /> otary Pu <br /> SEAL DeboMh D&'W <br /> o� NOTARY PMC <br /> v Commission Expires: <br /> COMMWNNM Oil RNKhLu b <br /> My Cancels W El"J*29,2018 <br />