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— <br /> • ,,1 BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACF/USETTS <br /> TOWN OF MASFLPEE <br /> DATE � t <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the . <br /> undersigned hereby decl/a'rc,(s)'iJthat a business under the title of <br /> Business Name/D13A: C., Fi1-661/t/ Corporation Name: is conducted at <br /> /131A �jCOU.I/Tl�y S�/LE-; <br /> Business Location: ZE�/� <br /> Business Mailing Address: D /�LQS GL,D .(7 /�L�J`/y IW,4 <br /> Business Type: 1!(9Lt-(f4,t>7WE- Tvvw/u Business Telephon/e/:� /�'�Q'/'��� 7 - 67-3 0 <br /> Flume Phone: �� C/ <br /> Email Address: YfI.lJL7LCViy/T.�0 VSq/L+ 12'05AI. C41--t <br /> by the following named persons: <br /> Owner/i Name Owner Residence <br /> /�itc/AC. ��Ji�Bp�o cttG Fp3S/�/ '�Z7s noAD <br /> 1"t4A kl L y!/✓ /Yl. /ff/G(J�O.e/.� C� SI�/F�L SGC/ /YG tI b�G� <br /> I certify under the penalties of perjury h 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. I ' <br /> 0 —IL� - C <br /> *Signature of authorized agent **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> "four 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 subiect to license suspension or revocation. This <br /> request is matte under the authority of Massachusetts General Law,Chapter 62C,Section 49A., <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss (/t DATE /1/�� <br /> all <br /> .2 1 �/l <br /> Personally appeared before me the above-named ✓✓J " ?EI Z 8'e6'VM and made oath that the foregoing statement <br /> is tl'ue. <br /> A certificate issued in accordance with if s" oon shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years thereafter so long as such siness be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> . t <br /> Notary Public <br /> • _. SHALxG <br /> {/mo^^� . <br /> w•DOWCommission Expires: <br /> WtAW PLOW <br /> , . Mncannrwn6lgn.�r <br />