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BUSINESS CERTIFICATE#08 <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 <br /> -De 1--0lCN DBA ` �/�/ /� is conducted at <br /> Business Location: J`Ll.�l'14uI� P��(� ICS- 11INS I f�lM�� Q�(P�4�-"I/ <br /> Business Mailing IS/�Adddrress: � 5�h+L"t� <br /> Business Type: NPCV49 S CC mQd1_h� Business Telephone: �7 oZ?JO O go� <br /> by the following named persons: C- V F, <br /> S L JDA i_0 I C� �A YI�IA��ID_W4 I� k4p_(,Q I I Yil� <br /> HomePhone: <br /> I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as required under lad <br /> *Signature of author ed agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> \Q a In case of emergency <br /> NAME: —1co .1/'-Lo(-gyp TELEPHONE NUMBER: yJ1�0p'�-Itrg�Z'!�g5`J-/ <br /> Alarm Company: N <br /> *This license will not be issued unless this certification is signed by applicant <br /> **Your social security number will be fumished 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 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 q <br /> BARNSTABLE ss 1� DATE <br /> Personally appeared before me the above-named M i �� 5 tl E L� ,� and made oath that the foregoing statement is <br /> true. <br /> A certi s to 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 yearhe after so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> � �f9�etAA.jENNIN(iS <br /> Notary Pudic <br /> SEAL tbl0lOf1YYEALTM OF AIAtiB!1pt1�ETTg <br /> mtai4,2M4eB <br /> mission Ex <,8010 <br />