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r- ` BUSINESS CERTIFICATE#07 g� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE U <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 /> twaC K_ Lt�4 )� Imo. DBA_ �Ate5 / is conducted at <br /> Business Location: Fi h_j_4 QD Amr <br /> Business Mailing G Address: <br /> Business Type: .1 . Business Telephone: �74 7 <br /> by the following named persons: <br /> �Jf/n�n�, K FU � � RESIDENCE <br /> �I.CJs f9A.YT[�' lV/-1�' PE rYIA •Da,� 1 <br /> Home Phone: <br /> I certify under the penalties o eq that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxe HYftlo law, <br /> Agnature of aut ori agent *Signature of authorizedagent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergenev C <br /> NAME:14 ri�ije t TELEPHONENUMBER50Q <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 subiect to license suspension or revocation. This request <br /> is made under the authority of iYtassachusetts General Law,Chapter 62C, Section 49A. - <br /> The Commonwealth ofNlassachusetts <br /> BAR\STABLE ss `' . ,,, =q DATE 0 <br /> Personally appeared before me the above-named 144144- �"�"`"7 R/Z— and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance this section shall be in force and effect for four years from the date of issue and shalt be renewed <br /> each four ye n ch ness shall be conductedandshall lapse and be void unless so renewed. <br /> Si ed <br /> • M M <br /> SEAL Notary Publi <br /> u�,,.. ;i L.MA711)CCHELLI,JR <br /> CMPIf9iFss0'n Exuires: - <br /> WMMONWEAUH Of MASSACHUSEM <br /> My CotmteS9ion EvMs' <br /> �% 0*W 2W3 <br />