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j• <br /> BUSINESS CERTIFICATE# 10-60 7 <br /> THE COAIMONIVEALTH OF MASSACHUSETTS / <br /> • TOItVN OF HASHPEE � n <br /> DATE � � � � —/ <br /> Fxpgration Date- nPPP1nhPY 31, 2014 <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 <br /> LPC—R IN DBA171 H MOM D 8661— *EAST)4 T� is conducted at <br /> Business Location: I(DD G°I!&AT rA&CSL P-08D lAU2IH i \ As OPEC— M A <br /> Business Mailing Address: (��� G R&A-1 N F--C\-/ RUA D N 1 }I,� - ' o NA} N FL-'(- M1� OZ6¢9 <br /> Business Type:27l_�SIN I Business Telephone: `�7 CQ - 4 -77 - 1 _500 <br /> Home Phone: 50 —+77 - 6000 <br /> by the following named persons: <br /> loo 69 4 Wi S N C�1Z V0 A D N01?I <br /> M t\�st\'PC-_f_ " tV\ ow +- ) <br /> I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> xes as requi.r tinder 1 ^ <br /> \y <br /> nahrre of authorized agent "Signature of authorized agent <br /> oZ �- f 7 0399- <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-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 Caaatoutvealth of Massachusetts f <br /> BARNSTABLE ss n ` DATE 1 <br /> Personally appeared before me the above-namedand 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 fo atS�ehCreafier so to suchq <br /> hall be conducted and shall lapse and be void unless so renewed. <br /> Sign Lt...t� ' n - <br /> JO WL. CHEW,JR <br /> SEAL Notary Public <br /> ComrAesElmrrd�sjm�pites <br /> 0610 W25.21115 <br />