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BUSINESS CERTIFICATE#I <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE S 3 ! <br /> • DATE <br /> Expiration Date: <br /> In conformity with the provisions of Chapter 110, §5 ofthe Massachusetts GepecaLLaaats tsamended,the undersigned hereby declare(s) <br /> that a business under the title of �e `U� <br /> /y� pp J / Lit 0.B : G'll <br /> �ea sin Hamra (&,. �tT"n Cor oration Name: more <br /> Business Name/DBA: P <br /> is conducted at Business Location: <br /> 34' L�wcto � 5F Commercial Residential_ <br /> I 7 / <br /> Business Mailing Address: 3 n``Ni'g`T- L w^ S` " ` Pip <br /> B�S�O3 <br /> Business <br /> /Type: M(arin2 n qac-or Business Telephone: <br /> New [X Renewal [ ]''II Home Phone: <br /> Email)Address: � l S co" <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> �n �� 5 Lc,i1.`� Gr,t r�� l�T`� /•�, 3 ��.t ��sl- lL for �A�u�c-�, <br /> a aSv 3 <br /> Second/Owner Name Second Owner Address <br /> 0, eirtify un er the p nalties 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 re ' d er law. <br /> 0 <br /> Signa f 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 /> 11 In case of emergency <br /> Name: C htIIS t f Telephone Number: <br /> Alarm Company: hJ <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 Conmrontveafth of Massachusetts BARNSTABLE ss ((' DATE�t_� DO l <br /> Personally appeared before me the above-named 11h Ha riS+e., . and made oath that the foregoing statement is true. <br /> A certificate issued ' ac o d cc with this section shall be in fibri:6 and effect for four years from the date of issue and shall be renewed each four <br /> years thereafter so s s cl business shall be conducted and shall lapse and be void unless so renewed. <br /> �ed <br /> Notary Public tary Public <br /> SEAL N+IIt Margeiet C.Santos 9-a a �,� <br /> j`AQ��(//�1 CotnmotrvreeMh of Massachusetts <br /> My Comm ss on on$ep1.� 2017 Commission Expires: <br />