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s BUSINESS CERTIFICATE#0807 <br /> Y <br /> 711E COMMONWEALTH OF MASSA CFIUSETTS <br /> TOWN OF MASHPEE log <br /> DATE Oil <br /> Expiration Date: December 31, 2012 <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 /> ?W Lyil e y1 sts LLG DBA_J0 D e4eaJi0A is conducted at <br /> Business Location: 919 I ra l OVA, •\[A �A I O I'I a �Y/. _ e�M/ ' 7 <br /> � - l <br /> G f / '� I <br /> Business Mailing Address: l 6h � <br /> 5 t4 zC- f� 6 <br /> Business Type: � D P.(�.�l� Business Telephone: Sy / 7 / � V <br /> by the following named persons: <br /> ice LVVLufse'- 3°lr�hlvs FOrh G ►��/rn04I Y1+ '01V13 <br /> Home Phone: J (7 ' ' 14'C)' Q_rU I CCA( 114 <br /> ertify under the penalties of perjury that I, to the best of my knowledge and belief, have tiled all state tax returns and paid all state <br /> es as require under law. <br /> OL W1 <br /> *Signatureo a thorized agent \ *Signature of authorized agent <br /> `// " a)-G a- I I //It C) <br /> **Social Security Number(Voluntary) /or Federal Identification Number - <br /> . In case of emergency <br /> NAME: ` I � <br /> (C1�v1 t�(�i' TELEPHONE NUMBER: / � l '�� _6 V o � <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 tiling 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 afMassachiisetts .Z./ <br /> BARNS'fABLE ss DATE <br /> Personally appeared before me the above-named J 44vt C_.%� k—b (ZSfk and made oath that the foregoing statement is <br /> true. <br /> A ceinfi e issued in accordance with this section shall be in force and effect for four years tom the date of issue and shall be renewed <br /> each four years th iea ter so long as such busi'nneests�shhall be conducted and shall lapse and be void unless so renewed, <br /> �ned tai p �v✓ l"--' <br /> Itttib <br /> ,SEAL - HUSETTS7 <br /> ies: <br />