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BUSINESS CERTIFICATE #09-07- <br /> THE COMMONWEALTH OFMASSACHUSETTS <br /> TOWN OF MASHPEE / <br /> DATE I !D <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 hereby declare(s)that a business under the title of 400 <br /> ] J <br /> //i�er )�VSSe DBA ( O�iS�i✓1 �' �jPc�erF is conducted at <br /> Business Location: lrl(1Ap(e - Cy <br /> Business Mailing Address: I-po & Ae j(,,S6 A10i pee Mu <br /> Business Type: ��pcwrry,u Business Telephone: -S110/ <br /> by the following named persons: - <br /> FULL NAME RESIDENCE <br /> ���ia ntiP� il�uscn �O Ncl-faitlu ''d � /hf�rx'� dN� •yam <br /> Home Phone: CGK-47 <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 tinder law. <br /> �iature of authorized agent *Signature of authorized agent <br /> *Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: (6,7- spa-Soo/ <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 01 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 /J orw <br /> Personally appeared before me the above-named ( �/1 S/T�d�e ^,,.�,& 1y-JSS-0 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 Gam the date of issue and shall be renewed <br /> each four years <br /> ^thereafter/so toting as such bn5h1C$ hall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> otary Public <br /> SEAL 010?' ngaessasandxguojSSuj woo 4m 4 .aN-� <br /> W 10 wleaMuouiW03 Commission Expires: <br /> 011£Ind AtJVION <br /> so;uesYu� <br />