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J <br /> BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE I �- <br /> Date: �l 0 t.e ► 6 DO 13 & I[ 1 <br /> Expiration Date: I <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 �� �T T <br /> Corporation Name: Business Name/DBA�rn ©HHG7A (/nHi/ITRC Tl Q <br /> is conducted at Business Location: <br /> — /,,Q 40 YW 0 S �An/'b i,•u Irl A _,ori • CJ <br /> Business Type: l n„l�Aonrt I n( P <br /> New [ ] Renewal [ ] --Commercial Residential [ ] Email Address: Amt, 4All t CnWA <br /> Business Mailing Address: J9!?A M n Q h A,,(- l/y r Q MA �d0 <br /> Business Telephone: ,i;ik t0 51 -.2, 7 G.� Home [ ] Cell [y] Phone: ,Sw 8- 7.Pk —alo0 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> ) <br /> I certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tar returns and paid <br /> all state to ces as required under law. <br /> 2:-� 8/Z,/- <br /> *Signature of authorized agent **Social Security Number(Voluntary) <br /> *This license will not be issued unless this certification is signed by applicant or Federal Identification Number <br /> In case of emergency // /- <br /> NAME: wn/n/ QVAQ.4 TELEPHONE NUMBER: k bOA-S-3 9-----12 <br /> i <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, ssDATE 6//1� <br /> /l3 <br /> Personally appeared before me the above-named__7l,//n,nA 57 rpwGIA and made oath that the foregoing <br /> statement is true. <br /> A cent cafe issued in Vorda with this section shall be in force and effect for four years from the date of issue and shall be <br /> renewed each f r years thereaft such business shall be conducted and shall lapse and be void unless so r n d. <br /> ed V� I Notary Public <br /> Notary Public Commission Expires 2d' aG I7 <br /> Margaret C.Santos <br /> Commonwealth of Massachusetts <br /> My'Commission Expires on Sept.22,2017 <br />