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BUSINESS CERTIFICATE#07X <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE � ) r <br /> • DATE (( <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 /> un rsigned hereb eclare(s) at a busin 's der the title of <br /> _ v DB } ,� . <br /> conducted at <br /> Business Location: <br /> Business Mailing AAt <br /> ss: �,1� <br /> Business Type: f Business Telephone: <br /> by the following named persons: <br /> ULL N M <br /> Home Phone: — D G <br /> I certify uow, <br /> of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> to a as <br /> l <br /> g a ur *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> p In case of emergency <br /> NAME: /�� �L'l fj r(� TELEPHONE NUMBER:99'_V9' <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 of Massachusetts <br /> BARNSTABLE ss DATE (o <br /> Personally appeared before me the above-named �/` � c/ S1`714V {x/'5 .tet and made oath that the foregoing statement is <br /> true. <br /> Atificate 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 year thereafter so I ng as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed (*)lz-<) <br /> J096PH L.MAZVJMHELU,JR <br /> .'•SEAL ri My Commission Expires <br /> OcMbet 25.2D13 <br /> ommisston Expires: <br />