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BUSINESS CERTIFICATE# 10�D S <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TO PVN OF MASHPEE <br /> DATE OC'C '71 20C)9 <br /> Fxpirat'nn Date- nRCpinher 31, 2014 <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 /> QAV 5(1;6f coitl _DBA is conducted at <br /> Business Location: <br /> Business Mailing Address: Ll Crw'bU'4C/C <br /> �— _ `/ l <br /> ,/ <br /> Business Type: SyC�/S 7 Business Telephone: `> U - /77 <br /> Home Phone: 7 O.� Y7/ ` �Ll6 <br /> by the following named persons: <br /> FULL NAMERESIDENCE <br /> MICH4L a . 12,q ��Cc4T;�'4Jwl% RP- <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 /> xes as required under law. <br /> OFz�/�� <br /> tgnaiure of authorized agent *Signature of authorized agent <br /> 2U3- y2 - 287'2 <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 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 ofMassachusetts <br /> BARNSTABLE ss \ r DATE <br /> Personally appeared before me the above-named JJI C N-l}.IyL J/7T�'1 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 conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • �6 <br /> lk- <br /> 0SEWdth SEALNota P ' <br /> OMMONWEALT <br /> Co s: <br />