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BUSINESS CERTIFICATE#09� e� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 0 1/a l l 1(.1 <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 - <br /> (30 6 (, S(!��V) CES DBA is <br /> p conducted at <br /> Business Location: ( 5 Pt M ES C I R C L E — ti A5 4 Q&E — tl i9 — O 266 y <br /> Business Mailing Address: (O S I�M C_ r f2 C 1 r— 5"P E7c 6 Y / <br /> Business Type: C 6 C ru �V Business Telephone: 509.5-29. 9t? pQ 7 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> 096 <br /> Home Phone: 509 J` j g$09 <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 /> as required under law. <br /> Signature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> (317ederal Identification Number <br /> Incase of emergency <br /> NAME: A �CU�?�� 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 Department of Revenue to determine whethe 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 U <br /> ]'� DATE / �/ <br /> Personally appeared before me the above-named Su MLl y J ��> and made oath that the foregoing statement is <br /> uve. <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 Mas such business shall be conducted and shall lapse and be void unless so renewed. <br /> as <br /> Signed (XXX <br /> 0 Ivor"40 <br /> SEAL COMMONWEALTH OF <br /> Coit es: <br />