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BUSINESS CERTIFICATE#09-&� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE f <br /> DATE I .3 I 00, - <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 <br /> �� hereby declare(s)that a business under the title of <br /> c <br /> n-eo �nbLl B,-cL k CILt b DBA C ILA ID Gf r)R w S�er, b r-y is conducted at <br /> Business Location: q5- 5hor-e-" 1) V "e.". Mus'fJ "I— "'°vSf,-� -I nlr^ 0ga&Lf9 <br /> Business Mailing Address: T\e.a -By'ooV, t� nu 5k � Da �L I <br /> Business Type:i p u rl I r�/ CI L4 Business Telephone: SO <3 - <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> )IS 0�� .$-� P-6. <br /> Home Phone: 9 '1 1 <br /> I ce tWK <br /> ify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> s er law. <br /> gnaturereof authorized agent *Signature of authorized agent <br /> 13- H003 9"�3 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> .�. - In case of emergency <br /> NAME: T.� �CC�o _ �Lt TELEPHONE NUMBER: 5 S - 9'a - �, 1 <br /> Alarm Company: , 3 I d.e Q 6—/L, 3-0$--3q y -()S,71 . <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 <br /> Personally appeared before me the above-named t�1�1_t_ .h ,n, —F &,.9 wand 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 /> ped & UIMMA VINCW JOYCE <br /> PM <br /> ura+won'!rIC .lLt a V N��vu <br /> MY Cot�ts�t ElrPutM <br /> AUGUST 1, 2014 Notary Public <br /> SEAL l <br /> �QWY tka �tt,GGwl uqm .1 , Zoll <br /> Commission Expires: <br />