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r <br /> BUSL'IESS CERTIFICATE#0$ <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE <br /> Expiration Date: December 31, 2011 <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 <br /> 4 NU rre aw t�S R eaj <br /> +_ is conducted at <br /> Business Location: I ( I -pG Irn'• �- -,+ a _ No 5A p.e.P, t mom. 0;L44 <br /> Business Mailing Address: SCL YKe, <br /> Recd <br /> Business Type: t.FCLI F 5IvAii­ <br /> Business Telephone: 5W - 4-7--?—b � �Y <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> 1�1 I Yr1�S CaYd o (� 3 Ale "VrAo✓ S O P r ilfd . <br /> Home Phone: - EO-54 Ft9(mdr/�'�t <br /> I ce rifv 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 /> Ask 1' 0M d, - Cys-, [z <br /> �igrature�f authorized agent 'Signature of authorized agent <br /> "Social Security Number(Voluntary) <br /> or Federal Identincation Number <br /> In case of emergency <br /> NAME: Vivre^:j ?r-+erCa/+doz4'� TELEPHONENUMBER: 500 X77-09?? <br /> Afarm Company: / 1 b T <br /> -This license will not be issued unless this certification is signed by applicant <br /> "Your social security number will be furnished to the Nfassachusetts Department of Revenue to determine whether you have met tae 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;bfassachusetts General Law,Chapter 62C, Section 49A. <br /> The Commonwealth of iYlassachuserts <br /> BAKNSTABLE ss DATE <br /> Personally appeared before me the above-name �lrnYEc-US- Gland made oath that the foregoing statement is <br /> true. J <br /> .4 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 Nears thereafter so long as such(b��Il'iiness shall be conducted and shall lapse and be void unless so renewed. <br /> SigneC�SC A L.Vt <br /> 0 SEAL . Notary Public <br /> s' es: <br /> 'VICK6ANN(3OVON1 <br /> Notary Public <br /> COMMONWEALTH OF MASxpires ETTB <br /> My(iWMT118SI0n Expires <br /> Ju 19,2013 <br />