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v <br /> BUSE*4ESS CERTIFICATE #07 V 1 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 2- 2-• Q 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 /> 1 C7 ff��lerX DBA 011701 is conducted at <br /> Business Location: ` 7 gp �aA 2Q 5'h Deo �V//T <br /> Business Mailing Address: H/ (9 QQ�1 a ci t P CRK <br /> Business Type: (dp��1 � 4 /M U / ' Business Telephone: SA Q �]7-f0 7d <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> C/ <br /> �//G/JP �CQI e/1/ l7 (olePflG�/1 t LCH L <br /> Home Phone: ��-5°7�-fQ�D "�— ✓ <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 /> taxes as required under law. <br /> onamre of authorized agent *Signature of authorized agent <br /> /'Z - !&Z- 0/a2 0,3 <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 famished to the rvlassachusetts 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 iivtassachusetts General Law,Chapter 62C, Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARVSTABLE ss DATE ZA- /3 '" D T <br /> r <br /> Personally appeared before me the above-named /4r/� _Z_',r relit/ 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 years thereafter so long as such busi shall be conducted and shall lapse and be void unless so renewed. <br /> Signed �,� - <br /> • - Notary Pu lic , <br /> SEAL Deborah F. Dami <br /> a NOTARY PUBLIC Commission Expires: <br /> Commonwealth of Massachusetts <br /> My Commission Expires July 24,2009 <br />