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BUS MI SS CERTIFICATE�01-6— <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE - <br /> DATE g <br /> • Expiration Date: December 31, 244-1 <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 /> LAtjraSCA,pF DBA is conducted at <br /> Business Location: (.o'er m u s e rc-1 tg„a s p_��� MA 07�,rJ,L� <br /> Business Mailing Address: ,.,,,ussSC-t Ma C'�G.Nq <br /> Business Type: Lgw1J GF1RC- Business Telephone: (SdB�3(0-1 -333 <br /> by the following named persons: <br /> FULL NA,\IE RESIDENCE <br /> A��aeci� Lo"c^ 1C6crtgtJ Z2 (c2 musKE� LAtiE rnAsc�PEE M9 <br /> Home Phone: <br /> 1 comfy 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 reouired under law, <br /> .nature of authorized a_ t *Signature of authorized agent <br /> O'<ll- t 0'a- (.,4l <br /> "Social Security dumber(Voluntary) ' <br /> or Federal Identincation Number <br /> In case of emergency - <br /> A�IE: At.�AEzo ca- KAP�E1u RAct<-wn) TELEPHONE NUMBER: <br /> Alarm Company: N )A <br /> "This license will not be issued unless this certification is signed by applicant <br /> "Your social security number will be furnished to the Nlassachusetts Departrrtent of Revenue to determine whether you have met tax tiling or taa <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request <br /> r made under the authority of Massachusetts General Law, Chapter 62C, Section 49A. <br /> The Commonwealth oj,11assachusetts <br /> BARIYSTABLE ss DATE CA <br /> Personally appeared before me the above-namel�fe(,6 D a�{yyy NTD and made oath tha[the foregoing statement is <br /> true. a, <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 [hereafter;o long as such busi�shail conducred and shall lapse and be void unless so renewed. <br /> Signed t - �'��qrw n <br /> �i�� l )(7Vnn <br /> - SEAL Notary Public <br /> O1\'f!eR!0AY VONT <br /> COMMONWEALTH OF MASSACHUSETTS <br /> my CAnQnission Expires <br /> to 2013 <br />