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BUSINESS CERTIFICATE# le?- <br /> THE COMMONWEALTH OF MASSACHUSETTS ( A� <br /> TOWN OF MASHPEE <br /> DATE T <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(DBANUtyJ((iA .l'_MOYDVft/11yIh'Xorporation Name: is conducted at <br /> Business Location: 1) GC)(4 R'"E Retia Q� e <br /> Business Mailing Address: � �� fs/VO— <br /> Business Type:h oVY1P I rA prove f)16+S Business Telephone: 7 N - 3 7' l lL O'�CI n <br /> Home Phone: .Z1 A- 691- i C3 S Email Address: qordoA , I rn I�KIV fVYt eN>`5/�`�li hdu. C o{'VI <br /> by the following named persons: <br /> Owner Name Owner Residence <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 /> • 'Signature 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 r / r1 gp <br /> NAME: Otlil1e M/Lh✓) TELEPHONE NUMBER: (pq - 05�23 <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 <br /> request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> BARNSTABLE ss <br /> The Commonwealth of Massachusetts DATE <br /> 1V <br /> � r <br /> Personally appeared before me the above-named 4t)1 _m <br /> Ul -I h-k// and made oiah 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 th 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 re wed. <br /> Signed <br /> Notary Public <br /> SEAL <br /> � Just <br /> Notary El <br /> RWICtinemMmCp1t OMWEALOtloOltIS <br />