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BUSINESS CERTIFICATE#09 Q� <br /> THF, COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE � D <br /> Expiration Date: DeCentheY 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) that a business under the title of <br /> ?.nBleQT s,g� DBA CIM_ Gf{W,,E 1AM)O ) GLEArI%WG is conducted at <br /> Business Location: (Q7 t#Qft F RD <br /> Business Mailing Address: 'PO NX 2YL& Alwft F <br /> Business Type: im Ajow_atANw r Business Telephone: SeZ- S k$-2-It 6' <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Rebw Sr bF]LO 187 f Pp1�E�0 M/kHPEF 626�q <br /> Home Phone: S*09• Z76 -1V9 <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 /> taxes as required under law. <br /> r <br /> Ao <br /> nature of authorized agent *Signature of authorized agent - <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number - <br /> In case of emergency / /�2 p -7 <br /> NAME: Af a (y ip TELEPHONE NUMBER: SOS• -77i7"7 J> L, <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 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 <br /> BARNSTABLE ss (/�� DATE f U <br /> Personally appeared before me the above-named l I 0 t3ag7 Jl^U A4,T�U0 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 fair 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 /> • a4.A����111��� 1F:dcft&2s.2oi3 <br /> 2E! <br /> SEAL ubo <br /> MAQSACWA <br /> 41 m s: <br />