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BUSINESS CERTIFICATE# (/// -03F <br /> THE COMMONWEALTF/ OF MASSACFIUSETTS <br /> TOWN OF MASHPEE / <br /> DATE <br /> •, Expiration Date: '1 <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declares)that a business under the title of C t4 V )2CH <br /> O C-9 Ai CO-D <br /> Business Nance/DBACW9-C} eXiE� b}' or mration Name J'7 YLe Cl7J`��-SEG/ 'C�s// inducted at <br /> Business Location: As-9S//}�0/c-G �'1-9/�' <br /> Business Mailing Address: /• �� B�x / / , / 1�, <br /> BusinessTypelupAl -F?ZFSZ F0,0lWTEQ/L/6- Business Telephone: .6-Oob 2-7 L/ "}�/,,r3e 17 <br /> Home Phone: ��� 9 7 7- 9 2 �j Email Address:S Nld� �( %4 9t-' <br /> by the following named persons: <br /> caner None Owner Rest nee <br /> -1"� �rtf � Co�G�ZCGf}�ra�9LC>1u�CH zs0 �� <br /> I certify under the penalties of pe ' y that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxe to un er aw. <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 /> i°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-fling or delinquency will be subject to license suspension or revocation. This <br /> request is made under the mnhority of Massachuseus General Law.Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss r( DATE <br /> Personally appeared before me the above-named C- and made oath that the foregoing statement. <br /> is true. <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the dale of issue and shall be renewed <br /> each four vears thereafter s I it, �-sus shall be conducted and shall lapse and be void unless so renewed. <br /> Signed C-t^� / <br /> Notary Public <br /> SEAL <br /> • Commission Expires: <br />