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BUSLNESS CERTIFICATE 9 07 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 23 F'E:6 0-7 <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 /> DBA l4e I��Ixjlti SS (�iC-�6>I t___js conducted at <br /> Business Location: <br /> Business Mailing Address: 10(-) }>( 2_(p2O OA t)i49 1A, <br /> Business Type:-ayb j122ND CY` Business Telephone: 77 <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 /> iitaxes <br /> as re <br /> tuq d under law. <br /> gnare o authorized agent -*Signature of authorized agent <br /> 5LD—9.5 73 30 1 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <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 /> BA&'vSTABLE ss <br /> The Commonwealth of Massachusetts DATE 2-�(Y3 v 7 <br /> Personally appeared before me the above-named ` ry "'�"� / and made oath that the foregoing statement is <br /> true. <br /> e,rtiftcate 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 a rs thereafter so to as such business shall be conducted and shall lapse and be void unless so renewed. - <br /> Signed <br /> JOSEPH L.MAZZIUNEW, <br /> Notary Public <br /> �'- pYONW <br /> NNf�fr�tF�lalEt�ues <br /> SEAL Odober?S 9 <br /> Commission Expires: <br />