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BUSINESS CERTIFICATE#07 �Lj <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE _ <br /> DATE �w 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 li�reby declare(sI)that a business under the title of ' l <br /> � iyAlo e—/ t4l b1�'LI0 DBA 216"472- -5 is conducted at <br /> Business Location: LIh 6L(y�-�' > <br /> / Ma 026, <br /> Business Mailing Address: / ( � 0-a-r- P/i/ 1 <br /> Business Type: ren ..,tlb inti, Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> s�umL/ 1p A-�ll�e_ mal , ee, � ozld <br /> Home Phone: L-62— V27—j 7SV <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 /> taxe as required under la <br /> tamre of a thorized agent *Signature of authorized agent <br /> 1 ,�-5a 38�cp <br /> **Socal Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: J .� ( I IZ-i U 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 tar 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 /> BARYSTABLE ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing 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 ye'rs thereafte -o long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> qrp ,JOSEPH L.MAZZUCCMIEIII,JR <br /> • Owt16F MRSEf9 <br /> SEAL MY Commmiat Fyptils <br /> pCWpg 28,2p19 <br />