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BUSINESS CERTIFICATE#09-Ok'p <br /> THE COMMONWEALTH OF MASSACHUSETTS 14TOWN OF MASHPEE 33101, <br /> DATE <br /> Expiration Date: December 31, 2013 <br /> In conformity with the provisions of Chaplet 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 /> c s / <br /> DBA � rs conducted at <br /> Business Location: ���U-f� �""'-'�� <br /> Business Mailing Address: <br /> BusinessType- ��^�� "�V Business Telephone: <br /> by the following named persons: <br /> FUL4N ME�� c RESID/ENCE'/, _ <br /> Home Phone: <br /> I certify under the penalties of p 'my that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as required trade I <br /> 0-"Otu- of horized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> m Federal Identification Number <br /> _���'��� J� In case of emergency q <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 Departinent of Revenue to determine whedhcr you have met faz filing e: sax <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 Continonrvealth ofMassnehusetts 3 <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named'j CSA✓1 .k 4'UOt 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 site Usines shall be conducted and shall lapse and be void unless sQnewed. <br /> Signed <br /> n c <br /> SEAL COMMONWEALTH OF * SSACH <br /> MY Camissilm E,tpm <br />