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l 'r <br /> BUSINESS CERTIFICATE#04_"I� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31,AO / <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 (1.�� <br /> A/1h i ltcc t MIClta eL 1 i" D'BMA z1 /\ \y� l �I is conducted at <br /> Business Location: ' "' "" r I l � p M O�_(D Y9 <br /> SCR VYI 2 <br /> Business Mailing Address: ` �/ C ' / <br /> Business Type: <br /> U3c '(neSs Je"tu's Business Telephone: ��o J`39 FWS— <br /> by the following named persons: <br /> EULLNAMEENCfE,� / ' � <br /> Michael acb� Kt� � V� <br /> 4onika6 Kb (/ 15 (liver ecQA IV6?syce Ira - <br /> Home Phone: 5� 0 53c/ V 5 <br /> 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 <br /> axes as squired and llaw. <br /> 'Whature ofi.djvidual �/ By: Corporate Officer <br /> 0j �&,) (0 a 3LSJ( <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 detemime 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 Z l23 I <br /> BARNSTABLE ss 1 ' t/� DATE <br /> Personally appeared before me the below named <br /> 6)o I K—� 7-�) 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 foul ears thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> gned <br /> c v <br /> • Notary Public <br /> SEAL Deborah F. Dami <br /> D ra <br /> e NOTARY PUBLIC Conus <br /> ♦ t�y��p// Commonwealth of Massachusetts <br /> My Commission Expires July 24,2009 <br />