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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> • Expiration Date: 31 <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: _Zn .2 IS ` Corporation Name: o IA <br /> is conducted at Business Location: �'�I _�AS S t' 1�`�— 1' p Commercial\eLResidential_ <br /> Business Mailing Address: G• 5 '� (`et�r' �—t 4� K� <br /> Business Type: / Business Telephone: (!p2_� I —f 6 aq <br /> New ( I Renewal JV� Home Phone: &\-I 6]a Email Address: - q �T("'• ,w` `t` �� <br /> by the following named persons: <br /> 'Co ame Owner Residgnce <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 /> ori 33 l ysa � <br /> gnature 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 /> I <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> "*Your social security number will be fumished 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 IO ZO/Z <br /> Personally appeared before me the above-named \lb'IMQ�S �md `c 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 long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed21 <br /> IC <br /> 4d <br /> Notary Public <br /> • SEAL h QW111 <br /> NpTA0*IM UC Commission Expires: <br /> CatlmanwltlN d Mntd�6 <br /> M/CamlNtlott famltu Jt/lf <br />