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R tl, BUSINESS CERTIFICATE#')_6 /Q O 9/ <br /> THE COMMONWEALTH OF MASSACHUSETTS 1-AL <br /> AL <br /> TOWN OF MASHPEE <br /> DATE ao , aG�o <br /> Expiration Date: <br /> � JjI <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) tha-tla business <br /> suunder the title of <br /> Business Name/DBA �/�/�7/�/iiJ%SCorpora[ion Name: is conducted at <br /> Business Location: � � <br /> Business Mailing Address: /jam' 7 !11 0411 �Zg�� <br /> Business Type: Business Telephone-_[� 1,y' 9y�O <br /> Home Phone: t�f//J'������ Email Address: <br /> by the following named persons: <br /> �,y-' rvne Mame / Owner Residence <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 /> ignature of apt tzed agent **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <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 Conuaon wealth of Massachusetts <br /> BARNSTABLE ss DATE QA 1G L aolo <br /> // <br /> Personally appeared before me the above-named`n .L I (L4,C a vt n o oo�S 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 renewed. <br /> Signed <br /> Public <br /> SEA <br /> • Margaret C. Santos q _ ,t{-aou <br /> NOTARY PUBLIC Commission Expires: <br /> Commonwealth of Massachusetts <br /> Liy Commission Expires Sept.24,2010 <br />