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BUSINESS CERTIFICATE 4 09 6 1 7 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> . DATE FEG'. i 7� 200 '5? <br /> Expiration Date: December 31, 2013 <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)thaatooa business under tire title of <br /> AL �t <br /> L6C- K:I .� O�N`' --Z3': A <br /> DBA L- PC(ZR`f 10L01h31A)& rKC'7RA6is conducted at <br /> Business Location: /i7 klPlldnl C('ecte- <br /> Business Mailing Address: c 1,PCGL"— 1h)Iq 4.6067 IV14 0 -2-6 � <br /> Business Type: R o l i e c- t yc-�4 A26 Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> oZ(.Cie <br /> 9 <br /> Home Phone: S D5' q-7 <br /> I certify 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 /> t es as required minder law. <br /> ignature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number- _ <br /> In case of emergency <br /> NAME: 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 tax fling 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 Coin inonivealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named 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 /> Signed <br /> • Notary Public <br /> SEAL <br /> Commission Expires: <br />