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BUSINESS CERTIFICATE#07,3 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE <br /> I <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 /> 5ramins � V t�Jr'wt <br /> SvlkjPS mY DBA /33,J3Sk e �g [� �( �14C/C� 't�is conducted at <br /> Business Location: 31 Me'Q'T14 A��6 ty W h � M&3 1, 6op e- P!O n e 4-19 <br /> Business Mailing Address: L)h r� 57 D '4' M e YY'tl th tbo w W a V m os ltP-- e i, A O d G `-4 <br /> Business Type: S�C9�� t`� Cvc9� CIS Business Telephone: 6i)�-N-, 8c) -3115_ <br /> by the following named persons: <br /> FULLS RESIDENCE <br /> j1itJ[Cztn 6 - VISr� �(o r�Pf^�f3y°�S lt[ vl <br /> Ifl✓Wz_S SCfI1/�51 /Yf S'RA , S �1/���i f�1/1 0 <br /> Home Phone: <br /> I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have f ed all state tax returns and paid all state <br /> taxes as required under law. <br /> .gnature of authoriz agent ,Si ature of aut o a or <br /> **Social Security Number(Voluntary) - - <br /> or Federal Identification Number <br /> L In case of emergency <br /> NAME:-L'1 S yi rog TELEPHONE NUMBER: _9�0u 3 6}_Y <br /> y <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 DATE / <br /> Personally appeared before me the above-named 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 Eearsereafter sJnuch business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • - `. - Notary ublic <br /> SEA:. <br /> > otnmissioHatBgpc <br /> COMMONWEALTH OF MASSACHUSlity6 <br /> My Commission Expires <br /> October 2S,2013 <br />