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' BUSINESS CERTIFICATE#� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE rna.ch a t ao t tS <br /> Expiration Date: A)tic c_t, .9 aO lrj <br /> In conformity with the provisions of Chapter 1 10, §i of the Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title of <br /> Business Name/DBA: ���J 1 �Corporation Name: <br /> is conducted at Business Location: Commercial_ Residential_ <br /> Business Mailing Address: �Po G <br /> Business Type: 7�Lgti.� Business Telephone: <br /> New A� l Renewal ] ] 11 Home Phone: u. ��/� -��T lOZ <br /> Em(a/il�Ajddress: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Second Owner Name Second Owner Address <br /> Ortify under 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 /> taxes as re�+wired under law <br /> /, El 3 yzl 567 <br /> *Signature of authori d 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: Telephone Number: <br /> Alarm Company: <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-riling or delinquency will be subject to license suspension or revocation. 'chis request <br /> is made under the authority of Chapter 62C. §49A of Massachusetts General Laws. <br /> The Commonwealth of Massachusetts <br />' BARNSTABLE ss /� DATE ((,1l _$ <br /> Personally appeared before me the above-named—Ha rl' . h� VO-1/1n 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 <br /> four years thereafter so long as such busin ss shall be conducted and shall lapse and be void unless so renewed. <br /> �ed <br /> Notary_ Public ' <br /> SEAL ' Deborah Dami <br /> NOTARY PUBLIC <br /> YYY Commonwealth of Massachusetts Commission Expires: <br /> My Commission Expires July 29,2016 <br />