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BUSINESS CERTIFICATE#07 -70 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE ZIL <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 /> u{{n��dersiggneed,"hereb<y declare(s) that a business under the title of �/J/ / <br /> (�79rcl�l— �)�mw DBA 6Ct% 5Ald <br /> t , is conducted at <br /> Business Location:,ptb/✓G( �✓/cS ems/ 6�� . � �FZ/� / 2 �� �o yCJ <br /> Business Mailing Address: 3kl M� <br /> Business Type Business Telephone: <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 rehums and paid all state <br /> taxes as required under w. <br /> f <br /> �4PP'Signature of authorized agent *Signature of authorized agent <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME/P"/5,'F �G w TELEPHONE NUMBERI/V-5; V-/fin <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 totheMassachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to correct their non-Fling 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 WA. <br /> The Commonwealth of Massachusetts - <br /> BARNSTABLE ss DATE / 2o <br /> Personally appeared before me the above-named 1[ZnAl 1- S 0 NJ 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 a uch business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed n <br /> Deborah F. Daml Notary Publi <br /> SEAL ° NOTARY PUBLIC <br /> 'r. Commonwealth of Massachusetts <br /> '' My Commission Expires July 24,2009 Commission Expires: <br />