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BUSINESS CERTIFICATE#07' f <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2011 <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 CC `fit <br /> DBA J�1 IUI\s+ iZeSOA <br /> s conducted at <br /> Business Location: /Y / Cr,,er 4- /JLi k_ CJ_ 50u <br /> Business Mailing Address: <br /> BusinessType: �e.SGv� Business Telephone: 50Cf— Y77- 0 <br /> by the following named persons: <br /> FULL NAMF� RESIDENCE <br /> E�w .cI Ubyrcea. erT,r s4eeS 33 7>?Afv 'Jt 5� /5�r/rq�zx, IW14' 001338 <br /> SCl^NLiv E`tCS�t - C-e_evt042�C� ���G/'�GWZ�r� <br /> i <br /> Home Phone: 3()&--c477— 41'1,16 <br /> I 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 /> it iaZsmd un `flaw* <br /> S afore ofauthorfzed agentz <br /> *Siknahffe of authorized agent . <br /> �`f6 - SS- 79,5 <br /> **Social SecuribrNumber(Voluntary) <br /> orrF&de_ angfication Num er <br /> In case of emergency <br /> NAME: Li 1 n « TELEPHONE NUMBER:SCS$=477- `Plat:) <br /> Alarm Company:j--4e. cwJy T /eyoit-s_ <br /> *This license will not be issued unless this certification is signed by applicant <br /> **Your social security number will be £umished 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 ofMassaehusetts <br /> BARNSTABLE ss � /�� DATE /647_/06 <br /> Personally appeared before me the above-named � n/� 0&/`�i S <br /> true. and made oath that the foregoing statement is <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 Cher jfterr so/long <br /> as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • SCOTT Vd DRAVIS <br /> Notary Public <br /> Co m mos ac h u s efts <br /> SEAL My Commission Expires <br /> Ma 2,2008 <br /> Commission Expires: <br />