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BUSINESS CERTIFICATE# Ll L-1 <br /> I -1( <br /> THE COMMONWEALTH OF MASSACHUSETTS p <br /> TOWN OF MASHPEE I <br /> • DATE \ .UX't1T 'M <br /> Expiration Date: Zd <br /> 01 <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��s under the title of <br /> Business Name/DBAA l w Wit(S I Y10fi0a1"�brpot"ation Name: <a*ly, is conducted at <br /> Business Location: 42 CIECK IW , bjas ' _e? jKli (1�t6q9 p <br /> Business Mailing Address: 'f o &X q�3 , mckgwer, <br /> Business Type: Ph 0 S <br /> 4mpylQ& Business Telephone: <br /> � <br /> Home Phone: 1 A6 Email Address: QS�I�@G1ShUQl JIILSV 10 12�(�•CC}'lii <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> A'Sh40 A JAW S N26IaVP/) �G1V�P 1llQ9hYJ�e <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 its required under law. <br /> A&M.I A, IA <br /> Wnature of a t orized 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 /> f \ In case of emergency <br /> NAME: cif r l N /l I I S TELEPHONE NUMBER: 90 t-Lf 21-S-7 D 9-- <br /> Alarm <br /> Alarm Company: fV �A <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 Massachusetts <br /> BARNSTABLE ss DATE Q u t,�17 <br /> Personally appeared before me the above-named (a-S h I Y.c f 1 n l l $ and made oath that the foregoing statement <br /> is 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 ere erso I pnA ag's t business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> 7S__A <br /> 0 No Public <br /> DAL � Notary Public mrd' <br /> Margaret C. Santos a <br /> Commonwealth of Massachusetts <br /> My Commission Ezplres on Sept.22,2017 Commission Expires: <br />