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BUSINESS CERTIFICATE# ro 99 <br /> r <br /> THE COMMONWEALTH OFMASSACHUSETTS <br /> TOWN OF MASHPEE ,r� y <br /> DATE <br /> Expiration Date: <br /> 0ntiformity with the provisions of Chapter 110,§5 of the Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> at a business under the title of <br /> f=—1,c—z—'112.1 G(/3ij <br /> Business Name/DBA:—IA4S-OI�CJ E �� Corporation Name: <br /> is conducted at Business Location: 43 1469-N&W Lf L1ULE7 Commercial_ Residential <br /> Business Mailing Address: Qa �.1P YLR� "A n'-2_('0gq <br /> Business Type: GUELIV I,C lam— Business Telephone: <br /> New 1K1 Renewal 1 ] Home Phone: _AJ��r <br /> Email Address: �E� �� � R1 (of. ( 11', 14co t COIN <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> —'"AtnD0(LE -F\+ Z(OWe A- f) <I2-> - rWna_nl&1Ee1�y < tP 1 ,ET <br /> Second Owner Name Second Owner Address <br /> ertify 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 /> as required under law. <br /> 0 17 -57o - l 2 t-f Z <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-filing or delinquency will be subiect to license suspension or revocation. This request <br /> is made under the authority of Chapter 62C, §49A of Massachusetts General Laws. <br /> BARNSTABLE ss <br /> Tire Commonwealth ofMassachusetts <br /> DATE <br /> .,-, 1 <br /> Personall ppeared before me the above-named 11SLGWLIE en 6w"made oath that the foregoing statement is true. <br /> A ceniE a issued in accordance with this section shall be in force and effect for four years from the date of issue and shall be renewed each <br /> four years ere cro long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Deborah Dami Notary Public <br /> • SEAL <br /> ° NOTARY PUBLIC <br /> Commonwealth of Massachusetts <br /> My commission Expires July 29,2016 Commission Expires: <br /> I <br />