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BUSINESS CERTIFICATE#01_01 3 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE 3 `--L N ' ,3O C'J <br /> Expiration Date: December 31, 2014 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 declarets)that a business under the title of <br /> ,/ ,[� <br /> DBA <br /> /�/�P�/t/1 �j/R)/�!/��/Jj'/��dOd�t�/�yll/�/� is conducted at <br /> Business Location: C26 ^5c f�T*V A..ttI GJ ,Q[ �i 0 S'^kAx1 v / r r/7 6O4 q q/ <br /> Business Mailing,"Address:&�0A Se t+0 0 h QUA AK's k'x p`mI7 646 �7 <br /> Business y e: /dAij (-MMT us/df Business Telephone: <br /> svBOWiin q7 �.ri9i�J �'� <br /> by the following namedpersons:A7 eloV��'YYw'�/'S <br /> FULL NAME RESIDENCE <br /> "le /AviK r_;b Se,1'Off *41 A f.J+s%.i7 r�o�.t�AWf,9 <br /> Home Phone: <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 and aw. <br /> gnature of author' agent *Signature of authorized agent <br /> o ra s-gan 7-q <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> / ^� In case of emergency <br /> NAME: �S/ D TELEPHONE NUMBER: ,jl7Y �/.3� QYl9 <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 sublect to license suspension or revocation. Tris request <br /> is made under the authority of Massachusetts General law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE 3� o7u- aGX�9 <br /> Personally appeared before me the above-named of i ry Z.. f U x_I 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 s ch business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Notary Pu lic <br /> • <br /> SEAL a Margaret G. Santos <br /> 'i <br /> NOTARY PUBLIC �-a4— �� C-) <br /> Commonwealth of'Massachusetts Commission Expires: <br /> My Commission Expires Sept.24,2010 <br />