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BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE <br /> JQ- <br /> Date: 3 d t, �`{ j 13 <br /> Expiration Date: .3 1 3 f 1 ) S( <br /> In conformity with the provisions of Chapter 110, §5 of the Massachusetts General Laws, as amended, the <br /> undersigned hereby declare(s)that a business under the title of <br /> Business Name/DBA: J Miller, Picture Framer Corporation Name: _�� <br /> Ill jl�;5 '0`e- s-"­41=- <br /> is <br /> 4. 41=-is conducted at Business Location: ad Certificate No. 2007-077 <br /> Business Type: Gallery, custom framing <br /> New [ ] Renewal [ ] Commercial [] Residential [ ] Email Address: <br /> Business Mailing Address: 144V Shellback Way Mashpee, MA 02649 <br /> Business Telephone: 508-539-3888 Home [ ] Cell [ ] Phone: 508-539-3888 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> John Miller 144V Shellback Way Mashpee, MA 02649 <br /> �certify u der theenalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> 11 state to s as qAuunder law. <br /> G/GFn(JtLnE IX- `'F 'A <br /> *Signature of authorized agent **Social Security Number <br /> *This licer .will not be issued unless this certification is signed by applicant or Federal Identification <br /> Number(Required) <br /> In case of emergency /J I <br /> NAME: S)IGrh yl TELEPHONE NUMBER: off" 2Gy 96� <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 Chapter 62C,§49A Massachusetts General Laws <br /> The Commonwealth ofMassuchuseas <br /> BARNSTABLE: ssDATE 3 ab <br /> Per�qrrd y ap eared before me the above-name�N//.✓ 'y' L L�-� 2� and made oath that the foregoing <br /> statement is true./ <br /> certificate issued in accordance with this section shall be in force and effect for fou ars from the date of issue and shall be <br /> renewed ea four y rs theceafter so long as such business shall be conducted and shall lapse ar b void unless renewed. <br /> igned Notary Public <br /> Commission ._._._..JA <br /> NOTARY PUBUc <br /> 00EptiN OF KMWAseTts <br /> My k4mm,Expires cla J5,2W <br />