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BUSINESS CERTIFICATE )- 0 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE• a O i DATE�1QI b, <br /> Expiration Date: ay 3I, a019 <br /> In conformity with the provisions of Chapter 110,§5 ofthe Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title of / ) <br /> Business Name/DBA: fV4e--r ., if, �7 IorporationName: �i(�4AII S'rf)IV She - <br /> is conducted at Business Location: /pa/) f;9J�tgdA Commercial Residential_ <br /> Business Mailing Address: SQ`ii: <br /> Business Type: "rL,d )eea'rmevt& z' ;/ Business Telephone: t_ Q �,j 3 9�� <br /> i <br /> New ] Renewal Home Phone: 5d9 0 .S <br /> I / <br /> Email Address: /JSCL ���y- (/",5- <br /> by <br /> /Sby the following named persons: <br /> Owner Name Owner Residence <br /> L/sa, <br /> '4eAz- e y /6 Q t&Gd1V t0 o"n) Ate / �joetJ <br /> Second Owner Name Second Owner Address <br /> Oert <br /> ify er 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 /> es a eq ired and aw. <br /> • ignatur of autho ' d age "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 q D <br /> Name: /(t �/-J-,Q,[� Di•!�/ZZ l Telephone Number: 7 — Z, -- <br /> Alarm Company: <br /> t <br /> "Your social security number will be famished to the Massachusetts Department of Revenue to determine whether you have met tax riling or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will he snhiect to license suspension or revocation. This request <br /> is made under the authority of Chapter 62C,§49A of Massachusens General Laws. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ssqq DATE <br /> Personally appeared before me the above-named (SCe- 'Ga_&A C/ and made oath that the foregoing statement is true. <br /> A certificate iss d in accordance with this section shall be in force an (Tett fur fou years from the date of issue and shall be renewed each <br /> four years th reaRer s ong as such bus' sttfs s�' be conducted and shall 1 e and be void unless so renewed. <br /> Signed <br /> • Ai <br /> Notary Public <br /> SEAT. o Deborah Dami <br /> NOTARY PUBLIC Commission Expires: <br /> Commonwealth of Massachusetts <br /> My Commission Expires July 29,2016 <br />