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BUSINESS CERTIFICATE it <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OFMASHPEE• DATE /�p pn 1 q <br /> Expiration Date: ✓1 OI <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 hl <br /> k1Business Name/DBA: 011" Corporation Name: <br /> is conducted at Business Location: IDI — PI i xz r gC1 Commercial_ Residential <br /> Business Mailing Address: 101 F Gr 1.X.�Pr2CJMt4S6or_e HFH ngb A] 9 <br /> Business Type: Nfi a--g0-,ade-JeWelfy4 f AC'C'.C'. &Xh!fS Business Telephone: /(01%z <br /> New I✓r Renewal I I _ Home Phone: CJD%- AO"1- 35Z3 <br /> Email Address: �{lfz tl�l tIQS QOI��I���n 7LLi�• CO✓n <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> S QeAnnCorv)n Int - 9el nk_r 0,MP MA- <br /> Second Owner Name Second Owner Address <br /> Ortify under the penalties of perjury that I, 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 /> C /24 ( "i61r� X40/ <br /> *Si ature of authorized 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: o��� �i��i(w Telephone Number: <br /> Alarm.Compa y: Al (,- <br /> "Your social security number will be furnished to to the Massachusetts Department of Revenue to determine whether you have met tax filing or lax <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 Common of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named�OOg f)rnn 0,M nI 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 -��— <br /> Notary Public <br /> SEAL Deborah Dami <br /> A,l <br /> 'IY1YM1i�Y NOTARY PUBLIC Commission Expires: . <br /> Commonwealth of Massachusetts <br /> My Commission Expires July 29,2016 <br />