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BUSINESS CERTIFICATE#06 "S <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE /,S-1— <br /> DATE <br /> ,S-1!DATE <br /> Expiration Date: December 31, 2010 <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 / yI <br /> T Ir. DBA /v t TeG �� rt�To `��7g i „J q is conducted at <br /> Business Location: /ti . A / /�/ e r ,vr N A Wj os yf°e e y k q <br /> Business Mailing Address: <br /> Business Type: AaI3,4 �,rTs c Tn r�.,ei4 Business Telephone: <br /> by the following named persons: ,J <br /> FULL NAME O RESIDENCE V <br /> -Z,m Ates 344. /6H 7-0 V/, �s />! �� � A, A oa � YF <br /> Home Phone: J�0-, `l7 <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 /> es as required under law. <br /> *Signature of authorized agent *Si o e ge <br /> gnq�fure of autho 'zed agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <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 11 DATE <br /> Personally appeared before me the above-named �� 2t 'e,S T✓/c/�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. p <br /> ed <br /> l�( V Deborah F. Dami <br /> ° - <br /> SEAL ,}� NOTARY PUBLIC Notary Publ c <br /> - <br /> �y( Commonweahh of Massachusetts . <br /> My commission Expires M 24,2009 <br /> Commission Expires: <br />