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r , <br /> BUSINESS CERTIFICATE {�� O <br /> • TOWN OF MASHPEE 1?()/ to t/ <br /> Date: p <br /> Expiration Date: <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 abusiness under the title of <br /> Corporation Name: EvE Foy �OL 0� 4LCBusiness Name/DBA: . 1 tV6 I he. <br /> is conducted at Business Location: <br /> Business Type: �/ ' -64a/L <br /> New[Renewal [ ]--Commercial [ ] Residential [ ] Email Address: <br /> Business Mailing Address: <br /> Business Telephone: SOS?�N4 h 149 Home [ ]Cell [Phone: 33e o�04? -7yy� <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> • <br /> f certify under the penalties of perjury 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 /> o?0 - C/02 <br /> *Signature of authorized agent **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/- T <br /> NAME: Voir rI6-mi-4 TELEPHONE NUMBER: -33cl-' � O(p '71/�V <br /> Alarm Company: T <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 Commonwealth pfMassachusetts <br /> BARNSTABLE, ss / DATE t <br /> Personally appeared before me the above-named and mali oath that the foregoing <br /> statement is true. <br /> A certificate issued in accordance is section shall be in force and effect for fo years from tEdate of issue and shall be <br /> renewed each four years thereafter g nett s such business shall be conducted and shall lapse be void w{ig so renewed. <br /> • gned Notary Public <br /> Commi o H L h!:diJG ELU,JR. <br /> NOTARY PUBLIQ <br /> C*M9W1y£1L'i:I Li;­1— CRUSEM <br /> my uoma.Ex^kaa Uct.16,2020 <br />