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BUSINESS CERTIFICATE# d! <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE 7 /1.5 /J6 <br /> Expiration Date: <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 /> 0/1's 1-N 012d w, DBA Q 11 S :17A/ okde C. is conducted at <br /> Business Location: 8 to She.14ack 60ct$� /14 asl% Oee. M A— 0D-1.V9 <br /> Pe 4041 -TV Easy So UJ% l mN+ oac.j7 <br /> Business Mailing Address: <br /> Business Type: Profess%ora O n9QA,Zfr%y Business Telephone: (S 08) <br /> (,5-00 3 8Q 6 967 <br /> Home Phone: ASO -L /F( -7 1 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> 0_7r) o�. (inn _0L B/O Sh"Iha-a 1A) r►1e?dpea M4 <br /> I certify under the penalties of perjury tha(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 authorized agent *Signature of authorized agent <br /> a a3 -&8- 8V37 <br /> *Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> 1 11 In case of emergency <br /> NAME: Tdhr, Ltr-, 1ap2S TELEPHONE NUMBEP-S509) 3q1 8�{!� <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 Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE ;a"20(3 <br /> �1 <br /> Personally appeared before me the above-named`�g /14x.c. 14 no I Qb2 it.- 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 /> se Margaret C. Santos tary,Public <br /> NOTARY PUBLIC 5 - dg- 20l o <br /> Commonwealth of Massachusetts Commission Expires: <br /> 41y Commission Expires Sept.24,2010 <br />