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t, <br /> BUSINESS CERTIFICATE#Q9 <br /> THE COMMONWEALTH OF MASSACHUSETTS <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 n /t 1' <br /> I( DBA ii ( ' (lam/ I wtn.,l.! is conducted at <br /> Business Location: �� TOrn.bcrr� ,, <br /> Business Mailing Address: 3a T'korn / Ctrcle- Mash ee— MA- ORbLq <br /> Business Telephone: ��og) 5-�� —pSa 9 <br /> Business pe: P <br /> �VLULa pGY �CI� <br /> by the to owing[[tame sons: <br /> j/tt II FULL NAME C I I RESIDENCE N <br /> l�nQ.f �en� � . Jl�e-LL.-� 3a T^hnoryl �r�-/ l.;Lt'C�e. M QShbe2� <br /> Home Phone:�50g� J�39—3 L¢ ` v.' 03_(o 149 <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 allstate <br /> t--cs as requhed under law. <br /> *Signature of authorized agent *Signature of authorized agent <br /> adLl 10 o -) <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: <br /> � TELEPHONE NUMBER: '5c>3 5(Pd- o13&c0 <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 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 CAV Coq <br /> Personally appeared before me the above-named li ox �f (Ak 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 /> • - ` =v�41 <br /> �C_\ Deborah F. Dami Notary nbli <br /> SEAL ° NOTARY PUBLIC <br /> Commonwealth of Massachusetts <br /> My Commission Expires July 24,2009 Commission Expires: <br />