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BUSINESS CERTIFICATE#0T�no <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2016 <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersignedhereby declare(s)that a business under the title of t� \/� /) (�7� �p D0 1 <br /> v!0 .^�f �o y DBA, I()N)6tj` 'S flp"f�/y(..) z/1.�j0lits co uct d at <br /> Business Location: /_� `I O 1� L �Y L—t\ _�\ <br /> Business Mailing Address: '? LSC \ ( �� I- --Z l�J <br /> Business Type: —ate&..t � Business Telephone: <br /> by the following named persons: <br /> FULLRESIIDDE�C j <br /> st a ,- �� � T �L�7 41 J �. 5!Ut\ R s <br /> Home Phone: <br /> I certify under the penalt ury that I, to the best of my knowledge and belief, have filed all state tax returns andP aid all state <br /> es gs required under aw. <br /> *Signa f au or�/ (� —irrz_& tt en *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <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 u <br /> BARNSTABLE as DATE /" / 07 <br /> Personally appeared before me the above-named r v 6i s;v%-h �44,T—I_k. and made oath that the foregoing statement is. <br /> true. <br /> A certificate i e 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 thereaft r so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> 07 6�H <br /> • Notary Pu lic <br /> SEAL <br /> Commission Expires: <br />