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` R BUSINESS CERTIFICATE#05 dg <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE t_ — <br /> DATE vQ l 131 ZDO�j <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 <br /> � T [DBA is conducted at <br /> Business Location: /QSO ' �30 3 946 64P <br /> Business Mailing Address: AM NA21101400 WWV gl f9�i !7 /1/I�� — n��(J� /gw ' / <br /> Business Type: Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> `Sb*K^ "Q,4 44V 3-79 WO.9i1T�,�eli <br /> "A- 622US 9J <br /> Home Phone: 63)2 <br /> ertify 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 as required under law. <br /> A) ice, <br /> 'Signature of individual By: Corporate Officer <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 authcrirf of Mcssachusetts General Law,Chapt:r 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the below named—,O`A\A k 1n,� ° )�u 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 /> �` EAL 00. Deborah F. D>� ;otary Publi <br /> S _ - <br /> rwrARr PUSUC <br /> CWMWW=0 of UMKWMft Commission Expires: <br /> COltl EXpkM <br /> JWY <br /> Z4.2= <br />