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BUSINESS CERTIFICATE#07 -! <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE t <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 <br /> Oo(-h n S <br /> -�ranws Oeo�ru'nQ 5efvi( S DBA UQnetne Medelro344I/J6N is conducted at <br /> Business Location: O T i m b-t r I G'-n 'D f iye- 1 ,H o,C d 1pe e, HA 026E _ <br /> m <br /> Business Mailing Address: 8 1- b-e f i a ne I)r;yc , MG$�� (`t A O a f q cl <br /> Business Type: C ecz nn 5Y Business Telephone: 00$ 8.26 - '75 8 a <br /> by the following named persons: <br /> 5023 - 7a • 8c 6 5- <br /> FULL <br /> FULL NAME RESIDENCE <br /> �id�1s�N Z.u-� s t✓lar�--,YIS � Tib-e / Iane f�� �� <br /> �Qn�tcle aroy1dao�} 1��1 no(e tbs 'h') 2-9 eeq. c A Dab y q <br /> Home Phone: �S 5390(, -0- <br /> -0- <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 /> taxes as required under law. <br /> "Signature of authorize gent vSignatureize agent <br /> V-93 - 74 - .SI Oa <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> �pp <br /> NAME: t�arws I�� TELEPHONE NUMBER:5_300&M-13 <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 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 � 1 A L DATE <br /> V � <br /> Personally appeared before me the above-named (�KA*--i 1)t= V r t't rY�(~hei'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 four years thereafter so long as such bb hall be conducted and shall lapse and be void unles enewed. <br /> Signed <br /> • SEAL . <br /> Nmry Public <br /> t.amma�� <br /> Mapper aola <br />