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f <br /> ' BUSINESS CERTIFICATE#07 f <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATEl�� <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 <br /> /hereby declare(s) <br /> that a business under the title of /` <br /> (Se✓L${G` —1 64t cl pini DBA J�Qt�i eel oe7*,,�a G�1� ftm is conducted at <br /> Business Location: n q <br /> Business Mailing Address: /"'z ' 1,9? 1(72— <br /> Business Type: Fr� (�`� Business Telephone:JPI <br /> by the following named persons: <br /> Fa�'2ULL N, E RESIDE�f CE <br /> �� �4 _ iL�r <br /> Home Phone: 56-- 1( 7'- Lo-?a' <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 /> 0�g7under i w <br /> *Sig6atfire of a ized 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 /> **'four social security number will be furnished to the ivtassachusetts 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 /> BARN STABLE ss DATE 4�1 Q :Z <br /> /' l <br /> Personally appeared before me the above-named 61-2 Uk 11)19' 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 th utter so I ng as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • E <br /> * Notary Public <br /> SEAL COMMONWEALTH OF MASSACHUS <br /> - Copes fres: <br />