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BUSINESS CERTIFICATE#077 <br /> 1J <br /> THE COMMONWEALTH OF MASSACHUSETTS -. <br /> TOWN OF MASHPEE �y <br /> DATE I — -; <br /> Expiration Date: Deeember 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 businessunderthe title of /� J 1 <br /> ILC?U�� Ccs I—O(�i`� 1 ��il i�/ DAJJp�yu( ( (�y�]CjIL7 I�(�/ is conducted at <br /> Business Location: () �S (�v-p'1'v` 96& CL trJ �A r— <br /> Business Mailing Address: 1/0 �(� S0.V�1(X 4�J l ✓\ e 12 k l ook pe f_ du 0&y j <br /> Business Type: ayr Business Telephone: So — y �� — (� 7(� <br /> by the following named persons: <br /> (� FU N E RESIDENC <br /> �V <br /> o�pe�S _4einki k �s <br /> PPI del t C +� J Vo joucpl <br /> Home Phone: d7 <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 /> taxesas required under law. <br /> I&ignature of at"tth6rized ageAt v *Sig of aut rized agent .. <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency / <br /> NAME: �a Clkt e �t,61CPo TELEPHONE NUMBER: SO '7 2E Of 6 d <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 ojMassachus tts ` <br /> BARNSTABLE ss Pb�Ir L_ ✓4-C / Zr;�f S DATE l 67 <br /> Personally appeared before me the above-named Tfi_tF F'E45!% k-1, •-t lk t-t-Al'ud made oath that the for going statement is <br /> true. <br /> Ace cate issued in)ccordance 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 h reattis s longuch business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed '� RM3 <br /> oeftff 25,2013'e' <br /> SEAL <br /> Commission Expires: <br />