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BUSINESS CERTIFICATE#07 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE f _ n <br /> • DATE / — 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 tide of <br /> / L(.a- DBA �Qn�/i�yl(( {41QcG.0.(Lq( �Lq[y j� is conducted at <br /> Business Location: <br /> Business Mailing <br /> �Address: _ �r r �VK I��� /Vl as � /+'lpr/ ryQ 16y <br /> Business Type: /tr I_a, gQ/ft`l.`p�cj� Business Telephone: ..�_Q <br /> by the following named persons: / <br /> �I FULL NAME RESIDENCE <br /> j��(7–�tt `_-7 <br /> Home Phone: � 0 - -l / 7—S Ut / 02 _ <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 /> •xes as required under law. - <br /> ignature of aithorized.agent .{'� *Signature of authorized agent: <br /> **Social Security Number(Voluntary) - <br /> or Federal Identification Number - - - <br /> I i case of emergency <br /> NAME: I r 1 arl C C I a6 r i(//t(- (_td 9a w ) TELEPHONE NUMBER: 6O <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 failto correct their non-filing or delinquency will be subject to license suspension or revocation. Ibis request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts Ancil O� <br /> BARNSTABLE ss /Jnr/,0 ( /y— �j/q/ DATE <br /> Personally appeared before me the above-named 1 wt `� ` Aldo 4 1-1' . 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 ereaffer.so Ion as such business shall be conducted and shall lapse and be void unless so renewed. - - <br /> ed � - <br /> n�e Deborah F. Da <br /> �J ° IJOTARY PUBLI <br /> SEAL ,� Commonwealth of Massach 4 200 Notary Pu is <br /> Ex <br /> fires <br /> mis..wn p <br /> My Com.. ; <br /> Comrtnssion Expires: <br />