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BUSINESSCERTIFICATE5b 407� <br /> TOWN OF MASHPEE _V l�, a 14)Date: L I <br /> Expiration Date: ]J <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as <br /> amended,the undersigned hereby declares)that a business under the title of <br /> Corporation Name: N� Business Name/DBA:1Rc ( UUSL <br /> is conducted at Business Location:/���l /l AT14-A J t LJ-0 I+R)q, 511l 1� N 6-L <br /> B ' ss Type: D c h f 6TI -r ' n '/ ��(7n <br /> (Nnew[� ] Renewal [ ] --Commercial [ ] Residential [ ] Email AddressCdQgaC V hVX eC0A6A3j <br /> Business Mailing Address: <br /> Business Telephone: Home [ ] C ] Phone: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> L(Z.IL ilk( 1;2 . u: 4r1L62 <br /> 1 cert' -]under th pen ie of er' 4' atthe best of my knowledge and belief. have filed all state tax returns and paid <br /> all a taxes as cqu' unde law <br /> zUA <br /> 9 <br /> *Si tureu orized� en **Social Security Num r (Voluntary) <br /> is license At not 614isued unless this certification is signed by applicantor"Feederall entlkation Number <br /> In caseof emergency <br /> - --t <br /> � <br /> NAME: / 1'I � I �� / TELEPHONE NUMBEU/, <br /> i <br /> Alarm Company: NVON 45 <br /> *'Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax <br /> fling 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,Sectio l 49A. <br /> The Commonwealth njMnssac/urserrr <br /> BARNSTABLE, ss n DATE <br /> Personally appeared before me the above-named C�L� 0 �V nil made oath that the foregoing <br /> statement is true. <br /> A cfawtucd in sicco ilh this section shall be+in force and effect for four yews from the date of issue and shall be <br /> rcne+r• ach liour years lh cr so Innes such husine� jcted and shall lapse and be void unless so renewed. /nom <br /> M. Tfssi�*'i otary Publi6T DI� ' <br /> 'V AL <br /> geiov••yFq i� '��, <br /> pqi� eY Z. 9•j mmissssiioonn Expires v �7� (Z <br /> i 3 2 e3 <br /> . <br /> BOC' <br /> 01 Neal) 5 . <br />