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c BUSINESS CERTIFICATE# 10- <br /> THE COMMONWEALTH OF MASSA CRUSETTS <br /> TOIVN OF MASHPEE <br />� • DATE <br /> Expiration Date: December 31, 2014 <br /> In confomtity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby'declare(s)that Ia 1b_usiness under the title of g t 1 l <br /> ANe_ dh a re-KC�K Cotx'kkiN c DBA is conducted at <br /> Business Location: (��P�I <br /> Business Mailing Address: �. Q--.in,, QS 75— <br /> /p <br /> Business Type: r ' p Business Telephone:ySy�S i7 - 7011 <br /> Home Phone: `� `-1 77—�0� /C) <br /> by the following named persons: <br /> Q FULL NAME RESIDENCE <br /> �I�A 1 `{�K �r3t� I,�nJ �.� �7 Nnf'✓ DCO'( <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 /> AlWes as required under law. <br /> �r <br /> *SiAar of <br /> tori ed agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: �^C_ TELEPHONE NUMBER: <br /> Alarm Company: \ rlq <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 Massachusetts <br /> BARNSTABLE ss DATE Z' C 0 <br /> Personally appeared before me the above-named PA- D 4i 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 to as such business shall be conducted and shall lapse and be void unless so crewed. <br /> fined <br /> SEAL NOTM OF jai <br /> t 8n xpires- <br />