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BUSINESS CERTIFICATE#07"S� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <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 /> `t�tJa?et 1n �a�� e DBA Nt; Ck\1YN2g Tyy\w,H is conducted at <br /> Business Location: 1`m W Ayf <br /> 1� <br /> Business Mailing Address: <br /> pl + \ t <br /> Business Type: U h�`�g t o t�l`q� Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> �eyEr� 3 �g;`� i90 Wgte� Waw ge- <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 /> ,dgKes as required under law. <br /> *Signatu�ofthonzedn *Signature of authorized agent <br /> - ax-�a �as�► <br /> "*Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency p Q <br /> NAME: 8; CN— TELEPHONE NUMBER: <br /> Alarm Company:_ C-C- Kc,V r <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 ofAfassachusetrs <br /> BARNSTABLE ss DATE '4[5j07 <br /> Personally appeared before me the above-named U4,r U and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section shall be in orce and effect for four years fromthe 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 x <br /> • Deborah F. Dami C51 <br /> ' NOTARY PUBLIC Notary Publ c <br /> SEAL Commonwealth of Massachusetts <br /> My Commission Expires July 24,2009 <br /> Commission Expires: <br />