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BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE u <br /> DATE <br /> - Expiration Date: s1 /17 <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: FW 14 VV5115A Corporation Name: is conducted at <br /> Business Location:' 75L�.21 hIVOtZ jettD <br /> Business Mailing Address: .SAMA <br /> Business Type: QK 14 R f-e.. �Ir_}-e.LT J C ' Business Telephone: -774 -931, -09 1 7 <br /> Home Phone: big -C-39 - �/(00 Email Address: f ti2i 1 PP E. M&Ro .Gc .+ . <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> %70gClnr PAL3tZt- o 7S Boo, 121✓c2 F>e"J) <br /> 2sas ider 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 /> e fit prized gent **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certificationis signed by applicant <br /> In case of emergency <br /> NAME: 16kmA PA I eem O TELEPHONE NUM 3ER: 5-0 8 -S 34 —19(00 <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 /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss ^q DATE <br /> Personally appeared before me the above-named U�1-�-r 1/!J/R��R V and made oath that the foregoing statement <br /> is true. <br /> A to 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 f years reafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signe <br /> Notary Public <br /> SEAL <br /> 'ssion ExplidBryPtmit: <br /> MYCttltnissionOF .. <br /> aWDb�3,70.Ib <br />