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BUSINESS CERTIFICATE#07a <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE , , l a 7W <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 <br /> DBA A`•-e�('11 ��/I Y' �1 is conducted at <br /> Business Location: •�� / J� �� {�of Y/c/ <br /> Business Mailing Address: S cw�� <br /> Business Type: t'7?(J Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> 140rr"- SAOe EPrd LIL) <br /> Home Phone: <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 /> s as required under law. <br /> *Signature of authorized agent - *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> ` In case of emergency Ce <br /> NAME: L P�V�. VI/n Q Y R Y C�r�`�C�jJ� 1 TELEPHONE NUMBER: L/ 7 o9 <br /> Alarm Company: 0 S <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 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 \ \ DATEQm�s��DxP <br /> Personally appeared before me the above-named�� Y��gf(J JVd'�r(,;Lt Sand 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 fou rs thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> d x t- 1VICKI ANN GOVONI <br /> Notary Pubic <br /> COMMONWEALTH OF MASSACN SMS <br /> otaryrnission Expires <br /> uly <br /> SEAL J 18.2013 <br /> Commission Expires: <br />