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M� BUSINESS CERTIFICATE#05 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <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 a business under the title of fy�A L,c/,� i Q113-(-7o2_�L <br /> DBA``_� P�il'le'l-]�.r14tf7 ��1.1�6+M,11d is conducted at <br /> Business Location: r{ t`19+< c.2S Cewe- ihtA�G tom_ {fitA 026y/ <br /> Business Mailing Address: -SAA <br /> Business Type: T)BA Business Telephone: 5_P8 737 b q! b <br /> by the following named persons: <br /> /FULL NAME �-o (` RESIDENCE yf <br /> Home Phone: )�_a 6 -737 C (5--b . <br /> rtify under the penalties of perjur th I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> Cs as req ' e nder lay.. <br /> *Signature of authorized agent *Signature of authorized agent <br /> 22 3 C8 n4,(,n <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 ���� n( DAT O ZfXO� <br /> Personally appeared before me the above-named f CX `( He `x\)o l,102and 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 /> ed <br /> Scommss <br /> � Deborah F. Dami <br /> NOTARY PUBLIC <br /> Commonwuahb of Masseohuselfe <br /> sEAL My Commission E*m Jury 24.200 <br /> es: <br />