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B 'r <br /> BUSINESS CERTIFICATE#09'o�b <br /> THE COMMONlYF.ALTHOFMASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE <br /> Expiration Date: December 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 M, <br /> ti <br /> �/�^���� <br /> DBA, J C ��� �j I to is conducted at J <br /> Business Location: �S l_.e. ) r Business <br /> S — <br /> Business Mailing Address: S-4- <br /> Business Type: &GlnJe. l I Business Telephone: 500 -?_3 7 34,0,j <br /> by the following named persons: eJ <br /> FULL NAME RESIDENCE <br /> Home Phone: <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 /> as required under law. <br /> es <br /> '174 12 <br /> 19 2 CZ <br /> rgnaf authorized agent *Signature of authorized agent <br /> **Social Security Number( oluntary) - <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-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 /> BARNSTABLE ss <br /> The Commonwealth of MassachusettsDATE /-'�C,t <br /> L (eY ZD�I <br /> Personally appeared before me the above-named 10 /7T! 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. l' <br /> Signed/ <br /> Qp <br /> Deborah F. Dami Notary P ibl <br /> SEAL � }� ; NOTARY PUBLIC <br /> 'i - Commonwealth of Massachusetts Commission Expires: <br /> My Commission Expires July 24,2009 <br />