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J= <br /> I BUSINESS CERTIFICATE # 10-_Ql Q <br /> TME COMbIOtV IVEA LTH OF AIA SSA CHUSETTS <br /> / <br /> TO IViV OF MASHPEE <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 declares) that a business under the title of <br /> DBA I�_ rIO_� ,nsoi. Ql. is conducted at <br /> Business Location: <br /> I ./A <br /> Business Nlailfn Address: <br /> Business Typ "-'\��pro. Business Telephone: SO'o ' /zz� — <br /> Home Phone: 5677- 3SSlx) \� St-r' fil{..Tz Iv• Fit for li 6- <br /> by the following named persons: 1 — <br /> FULL NAME RESIDENCE <br /> Zic <br /> It <br /> c ertify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> �s required tinder law. c� <br /> •Signature of authorized aeen *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> TELEPHONE NUMBER: 11 <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 /> j is madeunder the authority of Massachusetts General Law,Chapter 62C, Section 49A. <br /> The Couunontvealth ofMnssachnsetts <br /> BARt\'STABLE ss DATE <br /> I fd� <br /> Personally appeared before me the above-named V'4TI 4OLyr�f Yt I r C1WZ wand 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 /> eac our yea thereafter <br /> so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> El4Rk <br /> JCSFPH'LV=ELU.A <br /> rooter Public <br /> SEAL 0*4w 25.2019 <br /> Commission Expires: <br />