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BUSINESS CERTIFICATE#06-/9 <br /> THE COMMONWEALTH OFMASSACHUSETTS <br /> • TOWNOFMASHPEE " I r U_�c 2� <br /> DATE <br /> i— <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 /> undersi ed hereby fdeclare(s)that a business under the title of c r <br /> -�I.� n.1 'I.A-i I��^ DBA r C, ,1/l D 5 f I i�A a CI A't- is conducted at <br /> Busiges§ Pilon: (p Loot ipi?oe-wi Li ci Z-("4 <br /> , j <br /> Business Mailing Address: A S 1" F� /t D`Ls(' `I Ct- -4s&4 U <br /> Business Type: Business Telephone: 50 79 '*('o 1 r <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> =Fi%,A <br /> Home Phone: O lc) <br /> I certify 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 /> axes wired under law. <br /> F <br /> *Signature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> el� <br /> In case of emergency <br /> LI eA <br /> NAME:I/I L ��� C Vim` ' �� �s����) TELEPHONE NUMBER:' <br /> *This license will not be issued unless this c tification 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 Z CI w <br /> Personally appeared before me the above-named 414r tZJl(� 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 th after so long as such bu iness shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> NS•SON Ty0 <br /> • =?i OQUPPY teetO,,N 9 Nota�Pubfic <br /> SEAL <br /> a-0l Z <br /> :o Commission Expires: <br /> / QOF <br /> V <br /> /it IIPv�````` <br />