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BUSINESS CERTIFICATE#06_0` <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 /> i' (,sll nn /�J�QDBA K/ is conducted at <br /> Business Location: Z�_5 ��4 in / �GS���rga - (b`�'' / <br /> Business Mailing Address: �aA-. _ <br /> Business Type:_&L C�Y7( ro( Business Telephone: l 2 66.3 <br /> by the following named persons: <br /> FULL N I RESIDENCE <br /> 7 <br /> Home Phone: 7 l 63 ee <br /> I certify under the penalties of pe'ury that I, to the best of my knowledge and belief, have filed all state tax retltms and paid all state <br /> taxes as requ' d under law. <br /> // . — <br /> Signature Vauthoriz agent • tgnature auth rized agg t <br /> Qd_C" 6o2- �"6y �L- <br /> "Social Security Number(Voluntary) <br /> or Federal.Identification Number <br /> In case of emergency / <br /> NAME: �. G y TELEPHONE NUMBER: <br /> ��— �L <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 subiect to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth ojMassachusetts <br /> BARNSTABLE ss 1 DATE <br /> Personally appeared before me the above-named � i Mol- n-,. \ cJ nn; a 14^"1 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 J op <br /> y . <br /> • Margaret C. Santos Notary Public <br /> L NOTARY PUBLIC <br /> Commonweatth of Massachusetts y <br /> My Commission Expires Sept.24,2010 Commission Expires: <br />