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(' BUSINESS CERTIFICATE#07:S <br /> f <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE 3 <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 /> ('R:114 M DBA �n LA - lle C_14 L_f /117 is conducted at <br /> Business Location: 3b T�/n C a-, C I {— <br /> Business Mailing Address: (7X Z3� Y� aoP MA <br /> Business Type: C ,�1) /A I yl[ Business Telephone: 79 ) C) 3 <br /> by the followingnamed persons: <br /> FULL NAME RESIDENCEC , <br /> T_ <br /> Home Phone: 9W Q­r7 !�) ) -+Z <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 /> i na ire of authorized a6,ent *Signature of authorized agent <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 willbe famished 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 DATE f I/t 0 !e. 204 <br /> Personally appeared before me the above-named \)Y'-11 W MAQ� 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 as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> SEAL _ Notary Public <br /> ff <br /> Deborah F. Dami <br /> NOTARY PUBLIC <br /> j Commonwealth of Massachusetts Commission Expires: <br /> My Commission Expires July 24,2009 <br />