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BUSINESS CERTIFICATE a / <br /> TOWN OF MASHPEE <br /> • Date: l�e r? ) r70 <br /> Expiration Date: ri (90 1 V <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 /> I {{�� <br /> Corporation Name: 2 r y Ct rl D CL y Business Nam BA: Cra41 leer,-y Col /L tV e <br /> L <br /> is conducted at Business Location: /0 Jo!j J-fr�ET 1 /Y)CL�t /4/4 O 26 V 9 <br /> Business Type: Wall C6tFffa/td i4okne becov) /� / / <br /> New[V(Renewal [ ] -Commercial [/ ] Residential [ ] Email Address: b rya n la" Cra/c1�6Qfry co/%c</Ve •6oM <br /> Business Mailing Address: /o Joh JIVO� / / IOJ_A' gPi SMA 0 26 7 9 <br /> r U t t <br /> Business Telephone: TBD Home [ ] Cell [[lj Phone: / 6 - 2 T 6 5 a y7 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> 8r� an tau 3o 01CQ Cedar Lane <br /> J .Swot YofmotJ h, AM O266Y <br /> I certify under the penalties of perjury that I, 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 /> yi tiA � yG - L/y& 53 /8 <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 Jp <br /> NAME: 2AAI6� ga-ej TELEPHONE NUMBER: Sol 9/0 r n8-2 <br /> Alarm Company: Ca.ee- Cod A/n rin <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 Commonwealth of Massachusetts <br /> BARNSTABLE, ss DATE <br /> Personally appeared before me the above-named 6 r�l o n 11214 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 four ye(ar>1'*rcaRcr so long as such business shall be conducted and shall lapse and be void unless so te+�ed.Signed L6CAl.�.i�✓/ C� Notary Publicr�m 11l <br /> Notary Public Commission Expires <br /> ®� Margaret C. Santos <br /> Comlftomleallh of Messedtilsatls <br /> My Commis on Expaes on Sept 22,2017 <br />