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• � BUSINESS CERTIFICATE#08_LL <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2012 <br /> In confor-miny 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 /> —A .Se-, DBA — IA r C s conducted at <br /> Business Location: (=i <br /> Business Mailing Address: r vlg hpm __yq.Qw= /1 7 N r=t!y <br /> Business Type: Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> /arc; Lt <br /> Home Phone: -7 �/=g'�.b— �,3� 3 <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 /> Yes as, J�req iced tinder law. <br /> s <br /> tore aut - ed agent *Signature of authorized agent <br /> ) - A6 - ct-8 qa <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <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-tiling 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 /> BARtNSTABLE ssDATE a or <br /> Personally appeared before me the above-named / 1n}� 'LPrj F UQ.t and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in actor nce 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 thereat er so as s h business shall be conducted and shall lapse and be void'unless so renewed. <br /> Siened <br /> • Notary Pub c <br /> SEAL Deborah F. Dami <br /> s 4� NOTARYPUBLIC <br /> Commonwealth of Massachusetts Commission Expires: <br /> My Commission Expires July 24,2009 <br />