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BUSINESS CERTIFICATE# U O <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE DATE [L2 -LO!1 <br /> Expiration Date: 13f jp U <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declare(s)that a business under the title of <br /> � V f <br /> is conducted at <br /> Business Location: L�d IF (ndkt, Ld 0 -2— l2;AOw" A <br /> Business Mailing Address: S( mg , <br /> Business Type: Business Telephone:7�� '3`ij a <br /> Ij <br /> Horne Phone:�� <br /> by the following named persons: <br /> . FULL NAME .cul S"W 11 L <br /> }5d fjV, S! 62_ G Z <br /> I certify under the penalties of perjury t I, to the best of my knowledge and belief, have filed all state tax returns and paid all state -J <br /> Mazes as required illy er law. <br /> qW V\ <br /> ign tureof authorized agent 'Signature of authorized agent <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> *This license will not be issued unless this certification is signed by applicant <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 Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-muted `fftM��'�td made oath that the foregoing statement is <br /> true. ( <br /> A certificate issued in acro or with this on shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years thereafter so ong as so h business 1 all a conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Notary Public <br /> • <br /> SEAL <br /> ComNdW4dhA ttpires: <br /> COWMAiWEALIH OWF YAS,9Aptlli <br /> my ptirrmusion . <br /> 0mitigA 2018 <br />