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BUSINESS CERTIFICATE 3C (� <br /> • TOWN OF MASHPEE I CP <br /> Date: (�tc_ �f e'1�7 027/x/ <br /> Expiration Date- M,,A It.. a01 Fr <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as <br /> amended, the undersigned hereby declare(s)that a business under the title of <br /> /rT PC NFicT 66�Vc2iF770AJ THE NEJL i 6Es-NE2.47�0A) <br /> Corporation Name:lll�i/aaO1.tOCl� F2..QQ LAj6- 00 Business Name/DBA: .F{f}QD�y1DD FLDD�1A16 GC3 <br /> is conducted at.Business Location: // 11h n-ti1A1 112b. 1v] j_}l-Pe' sf /1A- <br /> BusinessType: MJZD1c1nnaD1 FL.66Z 7,e:'F/A11s /A/6,1-AJ57sr4,1q776A/ <br /> New[ ] Renewal [✓] --Commercial [ ] Residential [ ] Email Address: <br /> Business Mailing Address: <br /> Business Telephone: 504 419-24 1 _Home [ ]Cell [ ] Phone: 77J4i,2.3g' 80 9'] <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> KA-i}H LEW T- BA) FY 11 IJ/ A/ 4b ZIAKL6P�, MA <br /> • 1 certify under the penalties of perjure, that 1, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all state taxes as required under law. , <br /> "Signature of authoriz d a ent "Social Security Number (Voluntary) <br /> "This license will not be issued unless this certification is signed by applicant or Federal Identification Number <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 <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 Commonweolth of Mas'sachus'etts <br /> BARNSTABLE, ss DATE <br /> Personally appeared before me the above-named`CCJ4\%,e-eP-i k!" and made oath that the foregoing <br /> statement is true. <br />! A certificate issued in accordance with this section shall be in force and effect for four yem's from the date of issue and shall be <br /> renewed each four years ntercafter so long as such business shall be conducted and shall lapse and be void unless so mewed. <br /> Signed IC..a LLd4t,l r OLI Notary Public /n1,I may, <br /> Commission Expires <br /> r Notary Public <br /> Margaret C.Santos <br /> Comlmonwaft of Massachusetts <br /> Idy Commisslon 'res on Sept.22,2017 <br />