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BUSINESS CERTIFICATE#I D Z <br /> 4 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE p <br /> • Expiration Date: O <br /> In conformity with the provisions of Chapter 110,§5 ofthe Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title of <br /> Business Name/DBA: Su yl n 7 O(7� C t� /Corporation Name: <br /> Mis conducted at Business Location: 3�. �S� l �`�- 6h P�?� "J� Commercial_ Residential_ <br /> Business Mailing Address: <br /> Business Type: A Business Telephone: <br /> New Renewal [ ] Home Phone: . <br /> Email Address: / Un y\ Y "04(v eJ N9t( ' co (Y\ <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Second Owner Name 'Second Owner Address <br /> Ortify 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 or <br /> or Federal Identification Number(Required) <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> Name: Telephone Number: <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-riling or delinquency will be subject to license suspension or revocation. This request <br /> is made under the authority of Chapter 62C, §49A of Massachusetts General Laws. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss S DATE <br /> Personal appeared before me the above-named 3 `r 1' / �� h �VC 0,and made oath that the foregoing statement is true. <br /> certifi to issu cordane with this section shall be in force and effect for four years from the date of issue and shall be renewed each <br /> four year herea so longto s sue busin ss shall be conducted and shall lapse and be void unless so renewed. <br /> d <br /> Deborah Dami <br /> SEAL NOTARY PUBLIC Notary Public <br /> Commonwealth of Massachusetts <br /> My Commission Expires July 29,20Ih Commission Expires: <br />