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I BUSINESS CERTIFICATE#&0 "U <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE 6003110 <br /> Expiration Date: ii 3 d <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 /> SPl3 &�Mobk� DBA LIA QW� &e& rf/O Q a/2�by is conducted at <br /> Business Location: 3n Hnr<<e_Shoe Bend We-,T� SinP�SS C U On �a�afinn <br /> Business Mailing Address:--P.P. r7. Pix 1 3F, Where Clicnt Mooser <br /> lA., Irtns <br /> Business Type: Pj <br /> Af <br /> � 1r'),,:' <br /> �ra nht� Business Telephone: <br /> Home Phone: '508 '7V77 gy0 5 <br /> by the following named persons: <br /> 171 L.NAME RESIDENCE <br /> 1"1-OF{t,�cl cS/rY)C �YL� C!T <br /> &n Murkel+e. Snr�s� CT <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 /> UL M.tAIeAk� <br /> '9Wfgnature o uthorized agent *Signature of authorized ag <br /> ovs-SS-S/95 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME:c fa 111 Murk-e4-e- TELEPHONE NUMBER:94PQ 77R 7Y2--7 <br /> Alarm Company: 6/a <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 D <br /> Personally appeared before me the above-named 3 �Lt <br /> tUMurkeft� and made oath thatue 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 soglong <br /> 'as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed \ .0 _)tl_.��-Q I�/�/1 i�-rkkc <br /> SEAL <br /> OeboMh DaftPSC <br /> Notary Gc <br /> WCWMliWM <br /> commmulth l <br /> � EOM!�,id Commission Expires: <br />