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BUSINESS CERTIFICATE—f� <br /> TOWN OF MASHPEE t� <br /> Date: `(j1 L ( L( �Q <br /> Expiration Date: ` 13 6 /' 0 <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 t_ itle of <br /> Corporation Name: Business Name/DBA: FirsF iylAlt 171,40jn . ov, <br /> is conducted at Business Location: '10 41A oz,649 <br /> Business Type: 1� tomo �iL annv <br /> New[ ] Renewal [ ] —Commercial [ ] Residential[ J Email Address: keep P � ,PL4 ' -wM <br /> Business Mailing Address: L4 i•twxS(- A! r'''IASL eP Q _ M4 026`19 <br /> Business Telephone: (4 I'S) 1624-uzo'% Home [ ] Cell[XJ Phone: (4'h $29 -020; <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Ck J 14� NW.St, i{O Vvcc ,► A� lm'$6�t vAq u'264. <br /> PA-tc-ccl- A, r MAi1� ;11H OZ641, <br /> •1 certify under the penalties of perjury that 1, to the best of my knowledge and belief, have Sled all state tax returns and paid <br /> all stat taxes asquired under law. <br /> L—� Z}-4ltW;% <br /> "Signatur autrized agent "Social Security Number(Voluntary) <br /> 'Thislioansewillnot lswedunlessthis certification LsslgnedbyappR®rrt or Federal Identification Number <br /> In case of emergency <br /> NAME: So1.. 1 P,11t k TELEPHONE NUMBER: b l-S) 52Z-4 IL10 <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 sublect to license suspension or <br /> revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commontwafth ofMassachuseffs L <br /> BARNSTABLE, ss 1 _ DATE <br /> Personally appeared before me the above-named C L-1-� /j/ 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 years from the date of issue and shall be <br /> renewed each fo y�ars th er so long as such business shall be conducted and shall lapse and be v ' so renewed. <br /> signed ^— Notary Public <br /> Comm! o JOSEPH L MpZZUCCHEW,JR. <br /> .. - f,0 ..H FAITH of SSPGMUS M <br /> My Comm.Expires 0 L 16,2020 <br /> 2,. <br />