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BUSINESS CERTIFICATE# <br /> TIIE COjIfAlOtVWEALTH OF MASSACL(USETTS <br /> • TO IVN OF MASHPEE <br /> DATE 0 <br /> Expiration Date: December 31, 2014 <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned herreeby/declare((s) that a business under the title of e� <br /> V //��� � DBA / LeG�LG��/ is conducted at <br /> kJ/z <br /> Business Location: �� �� VGf//11�?o <br /> Business Mailing Address: <br /> Business Type: 1���er /GG�i/ Business Telephone: <br /> Home Phone: c� r- <br /> by the following named persons: j <br /> RE <br /> 0�1!/ ll //oma Gas oz ��/fOVI�/)N1 <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 /> xes4as!#R�-under, V. <br /> —*Signature fauthorzed 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 /> 22 <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named YZi 1't I\Cj� b and made oath that the foregoing statement is 4(K <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 /> ncd LN <br /> ICL kt 0 1. YA C -1 kU SO <br /> NotaryPublic <br /> .•r SEAL "Qo I S <br /> l <br /> Commission Expires: <br />