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i { - t;L--0 3 (o <br /> ( i BUSINESS CERTIFICATE# 20 <br /> THE COMMONWEALTH OF-MASSA CHUSETTS <br /> TOWN OF MASHPEE I <br /> DATE <br /> Expiration Date: S 3 I LO <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 /> are( . <br /> Business Name/DBA: •tr_ St0 Ae.(.��KS Corporation Name: <br /> is conducted at Business Location: cI<< UG�� -l �e— c. 1y� Commercial_Residential <br /> C9_ \`t k <br /> Business Mailing Address: _\ G-1e ) C� `� 'G Mas' `` q� e" A,( p.� <br /> Business Type: MUS a n ��1 Business Telephone: SD 3- ��//���— S 11-3 �j <br /> NewRenewal Home Phone: 503 q� Email Address: .5. CALlW �e tv✓1eCX1��S CrJ✓l� <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> S q h u eac/ a� UG I of c f (e <br /> I 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 s rr"9' du d under law. <br /> qFgnatu a of at torized 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 taxi <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C, Section 49A. / <br /> The Coauuonwealrh of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named Sri (?"AIIA- land made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with IN section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four year, ereafter on as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> i <br /> j Notary Public <br /> SEAL <br /> Pb kr <br /> Comrpii;* Fires: <br /> CGtMOMTAITH OF MA88ACIUBEI <br /> > tip CwwAsslon EVOUN <br />