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G BUSINESS CERTIFICATE <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE I <br /> • DATE 03 1/12 / 2 ruR <br /> Expiration Date:December 31,-22 a x'13 <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)thatta business under the title of <br /> gjllr-NNA1LS Dot f-N Q I1LV-%<K PatQN DBA_A?AAff eE V- r1l0PKA is conducted at <br /> Business Location: 116 /itvfkVl"J AvErtOE , M*1#4PEE h1A 01644 <br /> Business Mailing Address: 0& RIVE2VIEW 06 flue F Oklk PEE 11A 02649 <br /> Business Type: Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> 4PAA27EE` CkOPRA 116 Q(VEkVlew AYENuE, 11ASAPX Y1A 62649 <br /> Home Phone: .S o B - A 77 - 4325 <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 ed under law. <br /> na of auth�gent *Signature of authorized agent <br /> h (- 44-8786 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: .Sf1EL Av It C koPR A TELEPHONE NUMBER: SD Y - 221- 7 9 4 6 <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 Sling or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will he 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 Massachasems <br /> BARNSTABLE ss DATE �2-i a-2225 <br /> Personally appeared before me the above-named 'FF P Pr nr .3 P c T C I On.( � 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 therea .,o long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed �n <br /> SEAL Jill,/ <br /> Margaret C. Santos <br /> 1\ Notary Pub <br /> NOTARYof PUBLIC <br /> \ Commonwealth Massachusetts Commission Expires: <br /> 'Ay Commission Expires Sept.24,2010 <br />