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1 <br /> BUSINESS CERTIFICATE A 07. 6� <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 /> lN.e&,ZA6& C NE1L8P_0A/n/ DBA 6pe COD C.ouyTAy�t/4E3 is conducted at <br /> Business Location: 5*1FL.p s A-4-D , /s' 4;Fdlzr-c ld(4 d A&$1P - <br /> Business Mailing Address: .A aOoaep:pl ./ <br /> Business Type: !)01,4., Cy�.T� �F .,MA4Business Telephone: s6 d •S3 J ' 441 d <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> E� dS,L�a4D M <br /> < )Q/.d�-/�I'p� Hf�'/L/Bk'.at/.�/ �S�iS�/� �D S .�c�•9a /�'(.9LTiSl��/�b ,0 <br /> Home Phone: �a 6 rJ J T 7.3� <br /> I certify under the penalties of perjury that I, to the best of my knowledgeand belief,have filed all statetaxretums and paid all state <br /> �xes as required der la <br /> 7 <br /> *Signature of authorized agent 'FSiAKaturVof authorized agent <br /> s6 Y' S/.2SSPE <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number - <br /> In case of emergency <br /> NAME: L/$d .5Cu'La -3 TELEPHONE NUMBER:.S aS' V77 Sad <br /> Alarm Company: <br /> *This license will not be issued unless this certification is signed by applicant - <br /> **Your social security number will be famished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> -payment obligations. Licensees who fail tocorrecttheir non-filing or delinquency will be subject to license suspensionor revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> BARNSTABLE ss <br /> The Commonwealth afMassachusetts <br /> DATE 7 <br /> Personally appeared before me the above-named 1.t-J 1 III A41- e—' I4-r-_ K'52 /4✓and made oath that the foregoing statement is <br /> true. <br /> A.certificate issued in accord ce tth this section shall be in force and effect for fouryears.fr the date of issue and shall be renewed <br /> each four years thereafter so to as sue sines shall be conducted and shall lapse and be void unless o r newed. <br /> ed <br /> Notary Public <br /> SEAL - <br /> JOSEPH L MAlll1CCHELLI,JA <br /> . - C <br /> . <br /> COMMONWEALTH O'iFFd14M�EpG8 <br /> ETT <br /> *Cvw = 8 + <br /> . <br /> October 29,2013 <br />