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w <br /> BUSINESS CERTIFICATE#06 'a� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE -(7 <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 tittle of <br /> DC-E- . +OBA I Y T?,- is conducted at. <br /> Business Location: veoetr <br /> Business Mailing Address: tcB Esi,\YY1 ) l <br /> Business Type: HCx t (- 5 a k O f-1 Business Telephone: `j0 2, — 44 :1 7 Ca 19 -0),A <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone:S08--L _2-4k--�(4 <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 /> S <br /> Signa a ofauthori agent ` `— *Signature of authorized agent <br /> C�3os -] _::�, 5S <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency r�aa, <br /> NAME:MOY�IGUP / TELEPHONE NUMBER-SCOP-- 47'�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 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 3 l3 d <br /> Personally appeared before me the above-named 1A 0 Y1Q a 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 bt 'Hess shall be conducted and shall lapse and be void unless so renewed. <br /> Signe <br /> / 1 r <br /> _ - - <br /> Omy <br /> Deborah F. Dami otaryuisNOTARY PUBLIC <br /> CommotlWBalUI of M8SS8chU48lIS Commission Expires: <br /> Commission Expires Jury 24,2009 <br />