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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br />` • TOWN OF MASHPEE DATE <br /> Expiration Date: 3 <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: <br /> Corporation NamecT �-/l SJ M � /_/�s co/n�du�cte�d�a([� <br /> Business Location: n C c3cm-N VS �� 1�-�1►�7t'� l�/ A O'Z& T <br /> Business Mailing Address: .MTE:2 <br /> Business Type: r� Business Telephone: <br /> Home Phone: �� y',��I — t7\ Email Address: i�( 2,A<'�. ��l,t'tASr <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> OZlo�r1 <br /> 1 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 required onde law. C�eA --AA-�� -/ (,,.�,, <br /> (0 �51L5— <br /> ignatur ofut razed 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 famished 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 subiect 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 BARNSTABLE ss ^ DATE 3 <br /> Personally appeared before me the above-named �r�7a Cc,r t o l\ and made oath that the foregoing statement <br /> is true. <br /> A certificate issuedi a ordance 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 I g a such business hall be conducted and shall lapse and be void unless so renewed. <br /> Signed I ^t <br /> Notary Public <br /> • SEAL <br /> =Y. MMargaret <br /> Public. 9flnt0SCommission Expires: <br /> f Massachusettss on Sept.22.2D17 <br />