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BUSINESS CERTIFICATE aQ IS Oa <br /> TOWN OF MASHPEE <br /> • Date: / S <br /> Expiration Date: -3/3t/ll— <br /> In conformity with the provisions of Chapter 110, §5 of the Massachusetts General Laws, as amended, the <br /> undersigned hereby declares) that a business under'the title of <br /> Business Name/DBA: Peter L.Jacobson Plumbing & Heating Corporation Name: <br /> is conducted at Business Location: 71 River Road Certificate No. 2010-001 <br /> Business Type: Plumbing& Heating <br /> New[] Renewal D(Commercial [] Residential [ ] Email Address: <br /> 7/ PL'Vc­X ""q D <br /> Business Mailing Address: P6 Bev2449 Mashpee, MA 02649 <br /> Business Telephone: 508-477-9333 Home [ ] Cell [ ] Phone: 508-477-4051 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Peter Lars Jacobson ,J 2 71 River Road Mashpee. MA 02649 <br /> •1 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 /> 04-3232937 <br /> 'Signature of auPorized agent "Social Security Number <br /> *This license will not be issued unless this certification is signed by applicant or Federal Identification <br /> Number(Required) <br /> In case of emergency <br /> NAME: E"'e- If fi9�BSc^! TELEPHONE NUMBER: 5-,4-y77-3d <br /> SoB-34 9- 59/i Ce <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 Conononwealth of Massachusetts /� <br /> BARNSTABLE: ss I DATE 0 1 t 1 t,�, CP f ' 1 <br /> Personally appeared before me the above-named 3 ,c.U�)SOt—N 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• yearsstther ,er so long as such business shall be conducted and shall lapse and be void unless so renewed <br /> Signed, ' �/ t� Notary Public <br /> ese�oee� <br /> Notary Public Commission Expires oLt <br /> Margaret C:-Santos <br /> Commonwealth of Aiassachuseits <br /> �My Commission Expires on Sept.22,2017 <br /> i <br />