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.r <br /> BUSINESS CERTIFICATE#05 _G <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE Y aQ0 <br /> Expiration Date: December 31, 2009 <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 as b�ussiiinnessf under the title of n� <br /> x" /� /�!�//U / DBA /'<�/U / 'C�? -\ is conducted at <br /> Business Location: T VS i's /q 'I�Y�.C)fl e c ✓11+��n (� <br /> Business Mailing Address: 1 q S- zt9 i'✓t_GS' Ci /LI.P 1 �',,lt44"S h ®tP ; ✓)'1 c� 2 7 Y <br /> Business Type:c&>4 t Re 19Pi tll- Business Telephone: <br /> by the following named persons: <br /> FULL I1yyA�ME RESIDENCE <br /> J9nP�lony <br /> Home Phone: rj Q <br /> *rtify 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 /> es aasrl <br /> s�required under law. <br /> *Signature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <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 � Gti <br /> Personally appeared before me the above-namedAW lah4o 4 oLio 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 businessshallbe conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • Ci c Qr� YLe htaret C. Santos ��Q <br /> ota <br /> G <br /> NOTARY PUBLIC y Public <br /> SEALOommalwealth'of Massachusetts <br /> Ny Catindssfpn 6tpites Sept.24,2010 9- o u -rPow <br /> -- - - Commission Expires: <br />