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BUSINESS CERTIFICATE# go in <br /> • THE COMiYfONIVEAL THOFMASSA CI/USETTS <br /> TOVIV OF MASHPEE <br /> DATE � L?-/O <br /> I <br /> I <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 Nance/DBA: C{tV>rn 9&vE < Corporation pName: <br /> is conducted at <br /> Business Location: 1v1f, f�K'f` ,k l <br /> Business D'tailing Address: <br /> -- �� `� C2 1 mAS�P 0 Q 1rn, (j��.I Q�(p�� <br /> BusinessType�e�i'fl A..LX Business Telephone: S�t> � � 1 <br /> O -SAIL$ <br /> Home Phone: JrD G 6"'S4Email Address: <br /> by the following named persons: <br /> Oe'ner <br /> wn <br /> tame Oer Residence <br /> a.��> >e tea, C ���t, ,tet aaO o <br /> 5usA/� ML)'_rg73 <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 all state <br /> taxes Wrequired under law. <br /> AO_(5-0) 6 co 3 aa. <br /> 4,.-4nare of authorize gent "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 <br /> NAME: J vh n-P,e ,CA TELEPHONE NUMBER: 5fl� 'Si!O'SGI 1p <br /> Alarm Company: <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax feline or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The ConuuwnvealthofiWassachuse(is DATE <br /> BAILNSTABLE ss <br /> Personally appeared before me the above-named "`�.S a'� OS t7) and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the dale of issue and shall be renewed <br /> each four years there r so long as such usiness shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Notary Public <br /> • SEAL JOSEPH L.MA <br /> CJtIR191Y t3Aibtt Expires: <br /> COMMONWEALTH OF MA9SACHUSETTB <br /> My Ctxtun'ssion Expires <br /> 17L7a0er ZS,201$ <br />