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BUSINESS CERTIFICATE# 19—o 3q <br /> THE COMMONWEALTH OF MASSACHUSETTS PZ <br /> TOWN OF MASHPEE <br /> DATE /' <br /> Expiration Date: <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: W &L -�eN� 1 `' u0/ 5 Corporation Name: <br /> X/ <br /> -is conducted at Business Location: d d-NA/n /Zji5 9w& IT �t7 Commercial—Residential� <br /> Business Mailing Address: t 1 JAC-01 FII S' IIT�7 <br /> ' I � n <br /> BusinessT pe: Ndd-d Uphill q Business Telephone: �S3a-61s3 <br /> New Renewal Home Phone: Email Address: fllfk41G/1y.70 12( (o�rk'`�//�/J <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> C'hvl'S ��b�ie� CuZ— <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 as required under law. <br /> 0717d���y <br /> nature 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: TELEPHONE NUMBER: W C�15 <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 request <br /> is made under the authority of Massachusetts General Law,Chapter 62C, Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE 5j6 1 / <br /> .r^ <br /> Personally appeared before me the above-named fZ,t t Mp 9-k14I OP and made oath that the foregoing statement is <br /> true. <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 Ion 1rh hilciress shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Notary Public <br /> SEAL <br /> N aftyPLM . <br /> wllrlaREWN OF <br /> kV0MVel 4MEi;i= <br />