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BUSINESS CERTMCATE'A 0 6 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE �QtR 2�� 2rrGR <br /> • Expiration Date: December 31, 201k <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> unddersi2ned hereby1Ideclanre(s) that a business under the title of <br /> <tJe1Gp Y� L71 qq '1/t[ DBA - is conducted at <br /> Business Location: <br /> Business flailing Address: Q� // <br /> Business Type: rn C 6 rr mil' Business Telephone: 27r-336­ 1406 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> � rc.� Gtr• <br /> Belts <br /> sav� S d 7 L CSD ✓+ iii /a2�t4 d oe� <br /> Home Phone: 27ZY36—of 4 S2 <br /> I certify under the penalties of perjury that h to the best of my knowledge and belief, have filed all stare tax returns and paid all state <br /> taxes as quired under law. <br /> �7e A <br /> Wig. Lure of authorized a--V nt *Si_znature of authorized agent <br /> dzo -32-s s <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NA_�v[E: TELEPHONE NUMBER: <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 tae filing or tai <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license susoension or revocation. This request <br /> is made under the auth'onry of:.Massachusetts General Law, Chapter 62C, Section 49A. <br /> The Commonwealth gf:,Vassackusetrs <br /> BARYST.s.BLE ss ,�j , 1 Q DATE 7 � <br /> Personally appeared before me the above-named Il d 13 V/Q•yS0AJ and made oath that the foregoing statement is <br /> true. <br /> .4 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 /> Signed � /) <br /> • - Notary Public <br /> SEAL <br /> t 9.w ilc Cyour uw�u.I•u tx tre <br /> Nbtt51q FAM d <br /> COMMONWEALTH OF MA <br /> MY OOrntnW M Elm M <br /> oicbbbirm 1011 <br />