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' BUSINESS CERTIFICATE # <br /> THE COMMONWEALTH OF MASSACHUSETTS ta /J /l`3 <br /> TOWN OF MASHPEE C� <br /> DATE <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the undersigned hereby <br /> declare(s)that a business under the title of <br /> Business Name/DBA: B. Lynne Grove Corporation Name: Mashpee Vision Care is conducted at <br /> Business Location: 681 Falmouth Road,#B12 <br /> Business Mailing Address: 681 Falmouth Road,#B12, Mashnee, MA 02649 <br /> Business Type: Optometrist Business Telephone: 508-477-1802 <br /> New I I Renewal IV,/, Certificate# 2010-023 Expiration Date 1/31/2014 <br /> Home Phone: 508-477-1802 Email Address: lynneinma(aaol.com <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> B. Lynne Grove 455 Whistleberry Drive, Marston Mills,. MA 02648 <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 taxes as <br /> required under law. <br /> �urd 6fauthorized agent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency p <br /> NAME: L Ynn e- �To v e- TELEPHONE NUMBER: S08' y-2 $— 7 •p, <br /> 9� <br /> Alarm Company: s1,A C <br /> )— Nee_ qg — aolo <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment <br /> obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under <br /> the authority of Massachusetts General Law.Chapter 62C. Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing statement is 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 each four <br /> years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> l� LIMt/H_-1 <br /> Notary Public <br /> SEAL. <br /> Q0869lisi;iMMCC , Expires: <br /> reNOTARY PUBLIC <br /> oMWOMEALTH OF WSSACKUSERS <br /> My Canm.Expires OCL 16,2020 <br />