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BUSINESS CERTIFICATE#08 t U b7 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2012 <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 /> �jlei 0/ <br /> Business <br /> DBA conducted at <br /> Business Location: /? ,/{�/ yam,/ <br /> ��/ <br /> Business Mailing Address: ���p (,1��/ 5�/.S/� x9A t/ib`7//`�(,���r� <br /> Business Type: Gf/// Business Telephone:C � CP9/8S5;l _ <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone:C7i <br /> Aftertify 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 /> es as eq '' under law. <br /> * rgna u or zed agent *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 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 r/ <br /> BARNSTABLE ss DATE � t) ?-[1 tS <br /> Personally appeared before me the above-named i Og r�—�J V__- 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 there fter so 1 as ch business shall be conducted and shall lapse and be void unless so renewed. <br /> 0ned <br /> SEAL Notary Pub <br /> COItl1ONWEALTH OF ACHUSETT ' <br /> c�t �E, <br /> pves: <br />