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ab <br /> BUSINESS CERTIFICATE aeFf-6�/ <br /> TOWN OF MASHPEE <br /> Date: l <br /> • Expiration Date: <br /> In conformity with the provisions of Chapter 110, 45 of the Massachusetts General Laws, as amended, the <br /> undersigned hereby declare(s)that a business under the title of <br /> Business Name/DBA: Verde Floral Design Corporation Name: <br /> is conducted at Business Location: 19 Fountain Street Certificate No. 2011-019 <br /> Business Type: Florist <br /> New [ ] Renewal Commercial [ ] Residential [ ] Email Address: MONALAB@COMCAST.NET <br /> Business Mailing Address: 40 Salt Marsh Lane Pocasset, MA 02559 <br /> Business Telephone: 508-681-8169 Home [ ] Cell 7 Phone: 413-374-1651 <br /> by the following named persons: , <br /> Owner Name Owner Residence <br /> Jeffrey Anne Sawyer 40 Salt Marsh Lane Pocasset MA 02558 <br /> 181 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 /> I <br /> at a of authorized agent **Social Securit Number <br /> •This lip nse will not be issued unless this certification is signed by applicant ederal Identification <br /> Number(Requlre a7 61a0 <br /> In case of emergency ✓/ Q <br /> NAME: l0 TELEPHONE NUMBER:Yj . a 3 /, 3��/ <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,4 49A Massachusetts General Laws <br /> The Commonwealth ofAfassachuserrs <br /> BARNSTABLE: ss DATE Q oc'I S <br /> Personally appeared before me the above-named 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 /> renew ach four years the after so g as such business shall be conducted and shall lapse and be void unless so re d. dd <br /> •Signe r Notary Public 12_� � N <br /> Notary Publi Or - <br /> -Margaret C.Sa s Commission Expires <br /> CommomxeaBh of Massa'lusetls <br /> My Commission Expires on Sept.22,2017 <br />