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w• <br /> BUSINESS CERTIFICATE#07� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE ] <br /> DATE ' QLS �7 <br /> Expiration Date: December 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 business under the title of <br /> C.� ����r( DBAJ[A[ F is conducted at <br /> Business Location: <br /> Business Mailing Address: <br /> Business Type:wyia QWrIiiA5 Business Telephone: T7.r —a3�— a/pZO <br /> by the following named persons: <br /> FULL NA1 ff �^ RESIDENCE <br /> C�n��h, ,a r W� R (—G'rid lel i t 1Pf <br /> Home Phone: ( 0 8) —7— ­7 <br /> AdI ify under pe es of erjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> s a requir a <br /> igna f authorized 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 subiect 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 <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing statement is <br /> true. <br /> A ificate 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 y ars ereafer so long-as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • JOSEPHttto feHELL],J. <br /> .SEALNotary Public <br /> W <br /> COMMONWEALTH OF MASSACHUSETTS <br /> s pees: <br />