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Qd,d <br /> >,o -oGy <br /> BUSINESS CERTIFICATE#.94-_THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE O <br /> amt 4 <br /> Expiration Date: December 31, 26-H. <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereb9(— <br /> clare(s) that a'business under the title of �+ p p <br /> [-aIQ tl SS2 L l I DBA �l� mGJ T 0 Ts is conducted at <br /> Business Location: 109' �a f�Til t 7PO nA -IKO oA n0_5kpe -e_ 4 M Pr 7 <br /> /� /� <br /> Business Mailing Address:��c? �n+LAtt Co+ ncl go Y r #_s hbP_Z-y 1nA ID.-L&4/7 <br /> Business Type: .Zn�Bf'/1 Business Telephone: <br /> by the following named persons: <br /> nn nn FULL NAMEn / RESIDENCE <br /> 1 Wn+h /b8 so_rA A.1+ ?0(J �oad Mashlt ee4MA <br /> Home Phone:,5-09— '+' <br /> O8—` /7-3 (O � ���� <br /> • 1 certify tinder 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 /> tax as required u er law. <br /> *Signartue erauthorized agent *Signature of authorized agent <br /> I <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <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 fumished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax !I <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 w G �Se ( 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 such business shall be Simducted and shall lapse and be void unless so renewed. <br /> SignedJI A_14 <br /> Margaret C. San 0��,, <br /> NOTARY PUBLIC <br /> t Commonwealth of Massachusetts Notary Public <br /> SEAL My Commission Expires Sept.24,2010 <br /> q- au -aalo <br /> Commission Expires: <br />