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r <br /> BUSINESS CERTIFICATE# 10-_<9� <br /> THE COMMONWEALTH OF MASSAC$USETTS �t <br /> TOWN OF MAS11PEE <br /> • DATE <br /> Expiration Date: December 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 /> ppDBA � Q �o I�A. �c�i W is conducted at, <br /> Business Location: a o� a,YYp v�t� ho a <br /> Business Mailing Address: oda. �a1wxoJ F`oad if \�jS��eP KN'} ' <br /> Business Type: Do�!, oo. Business Telephone: SOS L177-J oq tr <br /> Home Phone: Cj a ^ 3q y- 019 <br /> by the following named persoosa,' <br /> FULL NAME RESIDENCE <br /> I S A,Aeo � ice <br /> A. DPK rs , H4-, O�01 <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 /> taxes as required under law. <br /> *Signature o a orized agent *Signature of authorized agent <br /> ot **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: J9 t, cve TELEPHONE NUMBER: 77l aIa'I Jo Q <br /> Alarm Company: , <br /> P Y <br /> *This license will not be issued unless this ce'r1itication 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 ss0"4--& <br /> t DATE <br /> Personally appeared before me the above-named L `V"4--& `l 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 thereafte)so long as uch business shall be conducted and shall lapse and be void unless snewed. <br /> Signed ` <br /> A 11 iVot�cgo�ebdit� <br /> SEAL 95 <br /> COMMONWEALTH OF MAACHUSETT5 <br /> MY Commission E►Pin» <br />