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BUSINESS CERTIFICATE 141 <br /> TOWN OF MASHPEE <br /> • Date: oo Vern bar d <br /> Expiration Date: VIOUevhber 361 SIS! <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as <br /> amended,the under <br /> (s''' ned hereby declare(s)that a business under the title of <br /> Corporation Name: I/l gun S�Jan/�ands/l('�A /�, �Business Name/DBA: <br /> is conducted at BusineI <br /> ation: / 1 /V C- r lBusinessType: //h v� <br /> New[ Renewal [ ]--Commercial [ ] Residential [ ] Email Address: �I/1! ��L/t n 77 rtkl)U rd#-7 <br /> Pd <br /> We - Lt4 UZ &� � 3 a- <br /> Business Mailing Address: r� <br /> Business Telephone:11 � IS Home [ )Cell [ ] Phone: 7f/ -7 3^ 35 � <br /> by the following named persons: <br /> /� Owner me Owner Residence <br /> Jthn ��� r nen <br /> I certify under the nalties perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> tate taxes as re ired u e law. <br /> " ature of u ho ' agent "Social Security Number(Voluntary) <br /> license will n t be issued unless this certification is signed by applicant or Federal Identification Number <br /> In case of emergency <br /> NAME: s,w Th ►un TELEPHONE NUMBER:5Uj/ <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 MassachuseUs <br /> BARNSTABLE, ss n� DATE X 0vy0aAA.. 9 0 a01 <br /> JL/ <br /> Personally appeared before me the above-named MA.Qe - �Onflen and made oath that the foregoing <br /> statement is true. <br /> A certifica issue in accordance with this section shall be in force and effect for four years from the date of issue and shall be <br /> rene 1 e ea t four y rs th a r so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> _ �t <br /> Signed- Notary Pub is OL(it J <br /> Commission Expires 9 - a a - DOl <br /> NoPublic <br /> Margaret C.Santos <br /> Commonwealth of Massachusetts <br /> 'Ry Commission Explms on Sept.22,2017 <br />