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I <br /> BUSINESS CERTIFICATE#06=i <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2010 <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 /> U I l9lll �n m 11 l_4�f ti/IC i e , Cts 1/ DBA/ // p/ / is conducted at <br /> Business Location:1 S 9 ©p II lua_, rul ��/iS A., '�Na7 '4 cl,e /n� O G <br /> Business Mailing Address: 2(p YIJr � 015 JIU7V yy f fit OYY M J7- DA L 119 <br /> Business Type: "� [ 7411eforBusiness Telephone: L'90O S7- /c? <br /> AS- <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> ' '72'Uwnes1Y9 COQ k'lt�Ieu �//I c Af.A� Ion S�i_ yy <br /> Home Phone: d'-o3?- Ifl�� Y( <br /> I certify 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 /> �esa// required under <br /> law. <br /> *Signature of authorized agent *Signature of authorized agent <br /> oYg f�nYw <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE 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 `` JJ -10 <br /> DATE �e�j� �G <br /> Personally appeared before me the above-named �L"iSnl2�f V-k T 0Vc t PS 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 year thereafter so I ng as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed aigt4, "'( � <br /> • ---fYY 1�CC C POaOr c,G �' <br /> Notary Public <br /> SEAL Margaret C. Santos <br /> NOTARY <br /> QNOTARY PUBLIC gay-�/o <br /> Commonwealth of Massachusetts Commission Expires: <br /> my Commission Expires Sept.24,2010 <br />