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• Oaf BUSINESS CERTIFICATE# 10-_C -2 <br /> r' <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TO PVN OF MASHPEE <br /> DATE <br /> Fxpirst nn Dote• nPt.'Pinhpr 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( <br /> (ss) <br /> lthat a business under the title of <br /> C) <br /> K f3 L 7 t fL/IY t 0 �,// DBA a e o� a t E �a ( � is conducted at <br /> Business Location: SL o'T L ,�,{ S p eC.. A o a <br /> Business Mailing Address:�('a 0 2C 1 1+ �"6 /'1 Ci S� L l P ft O- d L <br /> Business Type� Business Telephone: �Cd <br /> r <br /> i <br /> Home Phone: �� d $r) q-1 il - 0 9 9 q <br /> by the following named persons: <br /> FULL NAME // RE/ ENCE <br /> C -a it r <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 /> 5res as required under law. <br /> r/ � { (� - 0s_� a - <br /> g ature of auth(Wized agent *Signature of authorized agent <br /> ,41_)�1I #- o4 367 <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 Comaronivea(thofMassachusetts Z/ <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named f r r G t 4_ Lam!i ✓e rL and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with thissectionshall 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;2c r t <br /> • < Notary Publ c <br /> SEAL o� Deborah Oami <br /> NOTARYpUSUC <br /> commonwan myassutwsm Commission Expires: <br /> WC01"'VSWMEqkn July 29,2M6 <br />