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1 - <br /> � BUSINESS CERTIFICATE# 024 /07 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MA SHPEE U -Z <br /> • . DATE C'l <br /> Expiration Date: <br /> In conformity with the provisions of Chapter 110,§5 of the Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title of <br /> L-ICL�znl�,Al� trTT�- �,1� <br /> Business Name/DBA: � — Itj orporation Name: -�PS !� <br /> is conducted at Business Location: 01 Q : l2 L«Barry C'Qk?� Commercial_ Residential/ <br /> Business Mailing Address: e), /- o 5r <br /> Business Type: Lf 4/LO Business Telephone: —77c/ - 12.4-7311 <br /> New Renewal [ ] Home Phone: . S � <br /> Email Address: V�17 �` ccv-,cjkyT, s4L'f- <br /> by the following named persons: <br /> I <br /> Owner Name Owner Residence <br /> Second Owner Name 'Second Owner Address <br /> Certify under the erjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as requir <br /> 40 <br /> 'Signa thorized 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-filing 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 /> Tire Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE , 2] • � ( <br /> Personally eared before the above-named M21� N� �`� and made oath that the foregoing statement is true. <br /> A cert 'i ale issued nce wit this section shall be in force and effect for four years from the date of issue and shall be renewed each <br /> four years th after so to / usiness all be conducted and shall lapse and be void unless so renewed. <br /> �ed <br /> Deborah Dami Q_ � <br /> NOTARY PUBLIC Not Public <br /> Commortwem of maasachasm <br /> My Commission Expires July 29.2016 <br /> Commission Expires: <br />