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i <br /> BUSINESS CERTIFICATE#06 -ao <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE ( Q <br /> DATE �^ y a� <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 /> < aLJEU' Fl;r CZ:iZeVaLry DBA__ __ eoo c 51-too is conducted at <br /> Business Location: Z MU5te—r /A-U£. MA% A-PGE /Y/,3 62, 6! <br /> Business Mailing Address: 5/army ee , <br /> Business Type: RD✓p/LY5/4& ern L'Y Business Telephone: 2122 - !a/5 - 9(YfSS <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone: ap 3-¢7 <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 /> taxes as required under law. <br /> Oggnaturc o authorize t *Signature of authorized agent <br /> 67. 3 , x/ - 4?7` 7- <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: W- 366"g g 5�9 <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 DA � a3 <br /> J / � <br /> Personally appeared before me the above-named /n�;4 v 110 1�7- 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 the after so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed / E <br /> • o[ary Public <br /> SEAL Margaret C. Santos <br /> NOTARY PUBLIC Commission Expires: <br /> Commonwealth of Massachusetts <br /> QXy <br /> Commission Expires Sept.24,2010 <br />