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BUSINESS CERTIFICATE#09- 3 / <br /> THE COMMONWEALTH OF MASSACFHISE7'TS <br /> TO IIVN OF MASHPEE <br /> DATE <br /> Expiration Date: DeCenibe'Y 31, 2013 <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 /> ]A'(mbe( A• a"W DBA FL)I\ 61)ZC�fvM A I�\)OC4CtA is conducted at <br /> Business Location: 0 t-( h r 4 14okkc\,J Lane. a5 per MA D 2104 A <br /> Business Mailing Address: D C rA 4011 OyU yy\asyx Q t e M rA 6 210yt c� <br /> Business Type: (p rl-sW}i m Business Telephone: 508 - 2-q Z — 3l 3 LA <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> �� v hx✓Lti (� • T3aKe� �N D NnitovJ Lanz �Y�ct5hpe2 YVt� 02.1a4cl <br /> 'Home Phone: -5jof3 -53q '613c( <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 /> IItaxes as required under law.. <br /> e of <br /> ,/ithorized agent *Signature of authorized agent - <br /> D 3S5-2 1118 <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 n <br /> BARNSTABLE ss JJ /� DATE p� <br /> Personally appeared before me the above-named k I imr -Bret h• T t,o,4r 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 thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • Deborah F. Dani Notary Pu tic <br /> - SEAL ¢ NOTARY PUBLIC <br /> Commonwealth oi tts <br /> My commission Expi es July 24,2009 <br /> Commission Expires: <br />