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BUSINESS CERTIFICATE#06_:�ag <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOA'N OF MASHPEE <br /> DATE o2OO <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 <br /> -hl <br /> fl!(SDBA /(/I f�/�i„A 11 S �� J is�conducted at <br /> Business 6 (217adeS ©0�6 7 / ✓ <br /> -' �' / �� / l n L 1 <br /> Business Mailing Addre//ss__: .dr / , 4-/..s 7A-k �7�0 D11J C�- 1tweihelt 7 p�AIAX, <br /> Business Type: A4L ( Business Telephone: c ' <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone: <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 /> • tares/as required under law., - n <br /> lir�tA.f.E �V�AA.t <br /> *Signature of authorized agent *Signature of authorized agent <br /> 0�-aalo/9�5� <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> // / !/ ' In case of emergency fi <br /> NAME: /CArQ /�)"f/ S TELEPHONE NUMBER: �00 -390 3SIJ <br /> *This license will not be issued unless this certification is signed by applicant <br /> **Yom 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 <br /> request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth offMassachusedDATE 'C <br /> Massachusetts f� I� 106 <br /> BARNSTABLE ss �� <br /> Personally appeared before me the above-named �4 00 1 r"ruS 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 he void unless so renewed. <br /> Signed <br /> Notary Public <br /> c <br /> Commission Expires: <br /> XN PETER TAYLOR <br /> .., p Notary Public <br /> Commonwealth of Massachusetts <br /> - My Commission Expires <br /> September 14,2012 <br />