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a <br /> BUSINESS CERTIFICATE#079 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE ?I�0/01 <br /> Expiration Date: Deceinber 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 i <br /> 1�hCU�A/�/Q 41 S l„DBA 11f'e (I-4 � is conducted at <br /> Business Location: IS IVFYSIC� Ie P8 �PC01J Sri � CIQ SkbPP W4 Oa6 <br /> Business Mailing Address: �PP _ q.6 y e <br /> Business Type: �-eCt I E5Q-e, O(i�q cez- Business Telephone: 4 S '7 - i4 a 60 <br /> by the following named persons: <br /> FULL NAME RESIDE CE <br /> 0,l7cuyCt 0 Jr Uw_+IS 33 ��irldc t rtw CLS�(/�821 {� <br /> -r' <br /> '' y-// oa� �q <br /> Home Phone: L <br /> _ (7� ^ -3 X <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 /> Aokxes as.required under law. <br /> �vur•.a1.��1�./ <br /> *Signature of u (�nzed agent *Signature of authorized agent <br /> -.301 -16 7(. <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: �� �CIi�LCq�Ge �y TELEPHONE NUMBER: T `M <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 as DATE 9-/6 'r.)007 <br /> Personally appeared before me the above-named / /UhJ/!u-.70 nen ,BU!.k•P 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 ereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> ed <br /> SEAL Margaret C. Santos NotaryPubbc <br /> NOTARY PUBLIC ,-Notary <br /> )_ y�plb <br /> Commonwealth,ot Massachusetts <br /> Q)Ay Commission Expires Sept.24,2010 Commission Expires: <br />