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y ' <br /> BUSINESSCERTIFICATE�/3�OyNr <br /> TOWN OF MASHPEE P <br /> • Date: '10 Q <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as <br /> amended, the undersigned hereby declare(s) that a business under the title of C <br /> Corporation Name: Business Name/DBA: )nV�—f' ct ^ <br /> is conducted at Business Location:, , cL g I I kS S(2 N cl P <br /> BusinessType: t)iLAe_ 4- �r> Ctt. �+auA <br /> New[ ] Renewal Wf--Commercial [ ] Residential [ ] Email Address:ane �ti�L 5r� 6M(a Sf <br /> Business Mailing Address: I QU\t',a4 u i Ssn 'Aoc M 45�\oe& 1A ft Q,j 6 4 q <br /> Business Telephone: 572.4 7 7rIS S-3-Home [ ] Cell [ ] Phone: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> int-nut l' Lj�Q IAkha��l55� � jq} ) <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 <br /> all state taxes as required under law. <br /> *Signatur of authoriz d agent **Social Security Number(Voluntary) <br /> *This license will notbe issued unless this certification issigned byapplicant or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER:,](�� �I 7_7'dS 3 <br /> Alarm Company: <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax <br /> filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or <br /> revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE, ss DATE �' V <br /> Personally appeared before me the above-named !" V I and made oath that the foregoing <br /> statement is true. <br /> A certificate issued in accordance with this section shall be in force and effect for four y e from the date of issue and shall be <br /> renewed each four years thereafter so long as such b 'ness shall be conducted and shall lapse and c v id unless so renewed. <br /> •Signed� s Notary Public _ <br /> Notary Pork <br /> COmmI5510n COMMONWEALTH OF MASSACHUSETTS <br /> 51011"Pres <br /> 000&25.2013 <br />