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BUSINESS CERTIFICATE#09_[� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TO WN OF MASHPEE <br /> DATE <br /> Expiration Date: DeceinbeY 31, 2013 <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 1 <br /> Ilt_1 G f♦.1 P.,t L�,o l b l h i3 LL C_ DBA U �1 1L1 k) 0 nJ,"-- , 1 ' is conducted at <br /> Business Location: L� D ltd G l_' 1 f t.� U Q N-)Q.�.G L� S . <br /> Business Mailing Address: _f�(] rZ Z Y11 U 9 '7�:, VLo I LL4-i J kl A• 1)25 0 3 <br /> Business Type: _C aj-4e S uz Y Business Telephone: .,��• .So- <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> 7o i l YJ C � as A LP0 J)A. fir,4,� t40 MA DD ifs <br /> Home Phone: 1� (_ $ `i L <br /> I certify under the pena s of rjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> otxes as required on la <br /> lg <br /> ra f authorized.agent * ature of authorized agent <br /> S-1 - 169 Xti <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> 1 a In case of emergency <br /> NAME: II TELEPHONE NUMBER:SCE-X2_2- 43u <br /> AlatnnCompany: kLaiu, 'FOc'�„1nolA�`1 <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 Revenuc 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 Conanoatvealth ofMassachasetts Ia. D <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named 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 <br /> . Debora ami <br /> NOTARY PUBLIC Notary Public <br /> SFAL, _ 0my <br /> Commonwealth of Massachusetts <br /> Commission Expires July 24,2009 <br /> Commission Expires: <br />