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BUSINESS CERTIFICATE#08-/'D <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <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 T�� <br /> kris" L Ont rL ,rC DBA CQ�QY 0` JSlpy�s Pf 4�t Utl1 r� is conducted at <br /> Business Location: (8 &�r_c�t Le ftaskpc p I mp, m(Q49 `I /� <br /> Business Mailing Address: ��q�11 r� S\Op GlntkegAy, y t-t 01_30(9 ( <br /> ppX <br /> Business Type: 1` tLr_ 4ecLL±L (b-Gu-- Business Telephone: iSyL( - 00 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> r s 4,w LC',n(I{c�t e g9"I�J Shcp� Cs CY_Ac-Rz4R4, A <br /> y <br /> Home Phone: td nt..q .101- 139 2. 0 <br /> I certify under the penalties of perjury that I, to the best of nay knowledge and belief, have filed all state tax returns and paid all state <br /> xes as required under law. <br /> *Slililuirure of aut t rized agent *Signature of authorized agent <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: KYtSi--v[ CDuk .te TELEPHONE NUMBER: �LoI- <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 subiect 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 <br /> Personally appeared before me the above-named pit-i4eo L Cc�ta_{tkrc- 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 business shall be conducted and shall lapse and be void unless so renewed. <br /> Signe n,Tz` <br /> > rta . t <br /> Notary Publi <br /> SEAL <br /> mmission BAgary@LbGc <br /> COMMONWEALTH OF <br /> MVCpMd8ii0r1 <br /> - OEICElt' 1011 <br />