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BUSINESS CERTIFICATE# <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE1 I ' <br /> DATE <br /> Expiration Date: 113 <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 b�.u�-s�inness under the title of <br /> Business Name/DBA: Corporation Name: is conducted at <br /> Business Location: -A7 1,3049 [ >i w�P k0.5 (3�e thkik ca_( tLkcl <br /> Business Mailing Address: `�- L1P(n(a�S�tStrl -GJkei �A�rl M�' e12(0145 <br /> Business Type: ©AirJ t Q6. Business Telephone: c_zp-� L ciiw{ ;,,{ (Ce(t) <br /> Home Phone: C779S 'l ' . � l �' �C� LC2,� Email Address: OC'x\Y�l(�Ot -C-C((\ <br /> by the following named persons: J <br /> Owner Name f Owner Residence <br /> MaInc4pr> yell, C_ A\ra O'AI V-CC-3s �. <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 /> taxes as required under law. <br /> Signature of 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 /> In case of emergency <br /> NAME: VCR Cw tr�"�' 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 MassachusettsBARNSTABLE ss `^� DATE I D1t <br /> Personally appeared before me the above-named�l'�\d.'�CO S IGS \1�� and made oath that the foregoing statement <br /> is true. <br /> A certificate' ed 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 there le so long as such bu 'ness shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Notary Public <br /> • SEAL ANN <br /> _ <br /> ommiss EALTH t111i1tbNc <br /> WO <br /> a�nwrxttt of wes+ttalut <br />