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BUSINESS CERTIFICATE #09-4�0 <br /> THE COMMONWEALTH OI%MASSA CHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 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 /> C)rz\j I.S� DBA A�.V I , nO e- 1 is conducted at <br /> Business Location: alQTH C49' V i I I AGe <br /> Business Mail ingA'�ddress: 3� <br /> Business Type: Kele - Business Telephone: <br /> by the following named persons: <br /> PULL NAME RESIDENCG� C—ReATENeCK RCAJ <br /> � {N� MASVCC r�O oa649 <br /> Home Phone: �TJFS�s3c)—�� 1 <br /> I certify under the penalties of perjury that T, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as requited under law. . <br /> a (y) �� r <br /> tature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: —C-i&) N G K R l TELEPHONE NUMBER: <br /> Alar 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 /> Tire Connuomveatth of Massachusetts 1� <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named It ,O N - C l and made oath that the oregoing 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 /> 0CSEAL Deborah <br /> F. Dams Notary Pu lie <br /> ¢ NOTARY PUBLIC <br /> Commonwealth 01 Ms bac 24,2009 Commission Expires: <br /> My Commission Exp <br />