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BUSINESS CERTIFICATE # 10-_01_/ <br /> THE COMMONWEALTH OF MASSA CRUSETTS <br /> • TOWN OF MASHPEE <br /> DATE 3^ �i EC 7.00 <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 /> 1112ve6 s' (2E6A✓ DBA is conducted at <br /> Business Location: /6 S. s.d-wrJG✓tetG h2Gj <br /> Business Mailing Address: <br /> iBusiness Type: Business Telephone: <br /> Home Phone: S o 9 Cg J 7 <br /> i <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> /3 (1e,4 5 . (266-A✓ l6/ 5< SXY+ 04ite !e tzo <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 /> es as required under law. y <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: Y. 'F'9 ro <br /> I <br /> Alarm Company: dl//di- <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 to � <br /> Personally appeared before me the above-named j t C(l ,t QS �-tL— 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 ret owed. <br /> �gned <br /> 111 r t <br /> o c <br /> SEAL COMMONWEALTH OF MASSACHUSEn S <br /> CQ5mffia61atS,spfres: <br />