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Pill-' t,* <br /> , <br /> BUSINESS CERTIFICATE# —O 3,9-- <br /> THE <br /> ,9-- <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOIVA'OF MASIIPEE <br /> DATE_ LZ <br /> Expiration Date: 311 47/ <br /> In conformity with the provisions of Chapter one hundred and tcn,'Section five of the General Laws, as amended, the <br /> undersigned hereby declarc(s) that a business under the title of <br /> Business Name/DBA: �t _VO�W 7 plCorporation Name: is conducted at <br /> Business Location: ��O I f� n I 7 `fx� mQ��( t mA-o�.(�y Q/�l�ar�-d w/ /�1 <br /> 15Q <br /> - <br /> Business Mailing <br /> ''Address: p /� ^� �, U <br /> Business Type: Wd feSc, Ce�d- Business Telephone: ij ' `7' 7/ - RY6y <br /> r <br /> Home Phone: 5(o CA 107-7.-7L/' -7 L Email Address: ' 01 Qj'1YLa <br /> by the following named persons: <br /> Owner Name Owner Reside ce (� <br /> rinV 5� L.r'het%tu rn , �4VS�S r`� I_3 <br /> aycet(P <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 /> W-510natu a auth rized agent **Social Security Number(Voluntary) <br /> or Federal Identification Number <br />� *'Phis license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alar 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-fifing 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 Comotomvealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing statement <br /> is uue. <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 <br /> Commission Expires: <br />