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BUSINESS CERTIFICATE 9 D33 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWNOFMASHPEE DATE a Aon' t 694 'aD �5 <br /> • Expiration Date: �[ <br /> In conformity with the provisions of Chapter 110, §5 of the Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title of <br /> Business Name/DBA: 12 s"`-'1`"co Q (('" Corporation Name: <br /> is conducted at Business Location: I T CS S Commercial_ Residential X <br /> Business Mailing Address: S� w <br /> Business Type: d2, $ J- h c /-�' -fL` t Business Telephone: <br /> New Renewal [ ] Home Phone: u Lf 3 <br /> Email Address: " <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> ��,.. �•--� h raw���•„-d 3 S � 4..-t-�-- � ....,.., <br /> t - <br /> Second Owner Name Second Owner Address <br /> Ortify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as required under law. <br /> d���___ v t Lc <br /> au ortze agent "Social Security Number or <br /> or Federal Identification Number(Required) <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> Name: 5, (t M rl-w tF ^h Telephone Number: 4 <br /> Alarm Company: <br /> **Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request <br /> is made under the authority of Chapter 62C, §49A of Massachusetts General Laws. <br /> The Conmeonwea(th of Massachusetts <br /> BARNSTABLE ss 1&,,g,-4 DATE <br /> Personally appeared before me the above-namedA ,,C, (� and made oath that the foregoing 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 renewed each four <br /> years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> �ed'.���� ,� �Xo!✓1 X �YQG�-� <br /> Notary Public <br /> SEAL Deborah Dami <br /> ' NOTARY PUBLIC <br /> Commonwealth of Massachusetts Commission Expires: <br /> My Commission Expires July 29,2016 <br />