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e . <br /> , <br /> BUSINESS CERTIFICATE#04_ <br /> T THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> iDATE 30 5 <br /> a <br /> Expiration Date: December 31, 2-ON <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undeerrrssiiggned hereby declare(s) that a business under the title of <br /> FI✓i S ST AV'V,13 DBA /4t1,17-fe0lW <br /> is conducted at <br /> Business Location: <br /> Business Mailing Address: L? q p�X Z 2 J;-7 <br /> % <br /> Business Type: c_ t e/dO Business Telephone:_Sde- �6 a <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> ��irts •/!��'/'�P� 2� Ti}'Gr �to/irG, ^ CLOG <br /> /� 'i 00�e eni da.,s sof <br /> Home Phone: S 6, 5 0`�-el` Cu <br /> Isrtify 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 /> s�as require under law <br /> *Signature of individual By: Corporate Officer <br /> O 3Z -G(0 -9S�/ <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 famished 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 subiect 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 <br /> Personally appeared before me the below named C (.--s I WC Cci, 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 Ion as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> �.iC'lj 59A '.� w <br /> o,i �8 C. Notary Public <br /> SEAL (1�Ifi <br /> NOTARY PUSUC <br /> 'wOIIIOIIwub0I� Commission Expires: <br /> 0Nrcat hEVras ol.2412Mo <br />