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P <br /> BUSINESS CERTIFICATE#05_1� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2009 <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersized hereby declare(s)that a business under the title of <br /> ///CXI/t DBA S �`f'�l is conducted at <br /> / / A�7z- L <br /> ,t,tQ OZ6 <br /> Business Location: 6 9 d(/ �� �-ra >~ <br /> �y�l / sV <br /> Business Mailing Address: 15/19�1 (, <br /> Business Type: ?>Y ;2eA,6A Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> tie <br /> Home Phone: <br /> �:ertify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> utxes as requireed� dd . <br /> *Signature o By:Corporate Officer <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <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 below named to and made oath that the foregoing statement is <br /> 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 <br /> each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> a <br /> N lic <br /> Commission Expires: <br /> .3 <br />