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y BUSINESS CERTIFICATE # 10- IV <br /> THE CONIMONIVEALTF/OF MASSACHUSETTS <br /> • TOIVtV OF NIASHPEE <br /> DATE 112 / <br /> Expiration Date: DeCeinbet- 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 busi)�ejs under the title of <br /> /7'i/ /� /l R7/ / <br /> h�/ZGii/ ,� em7n DBA (>a/i•f-�1 /4%2 CG/If2G! is conducted at <br /> Business Location: // /f /-din <br /> Business Nlailing Address: .Sa/nom <br /> e. Y,-7Z Gri-r cti/n <br /> Business Type: "Business Telephone: Sb lam— Y�'7�•��� <br /> Home Phone: ;2 ?90 <br /> by the following named persons: <br /> FULL NAME RESIDENCE / <br /> in i�S_ �l7Y�S // sin 7`ri f /,ond led <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 /> ees as required under law. <br /> *Signature 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: <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 of Mnssnchusens <br /> BA1L\STABLE ss ,,rr�� 'II DATE /0�-/7- r7CG 9 , <br /> Personally appeared before me the above-named �/YJPlOO 61OLeirov) 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 /> V V1�aQ <br /> Margaret C. Santis !lv Notary Public <br /> SEAL '�t, NOTe"' UBLIC <br /> �y Commonwealth of lassachusells 9 )(4 7O)0 <br /> Viy Commission Expires Sept.24,201u Commission Expires: <br />