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. O 1 1 <br /> BUSINESS CERTIFICATE#06 —J I/ <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE qQn e a0 aUd/(j <br /> Expiration Date: December 31, 2010 <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 /> _DBA�GI ( \I \r�� e( l) 1 CPS is conducted at <br /> t \ <br /> Business Location: ZZ LD Vth1\v �1 <br /> Business Mailing Address: -e.Q <br /> Business Type: t\ Business Telephone:'N-I <br /> I q ��QgNI <br /> by the following named persons: I <br /> F L NAME ``RES E CE <br /> �� <br /> Home Phone: <br /> �ertify 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. .. ,. <br /> *Signature of authorized agent *Signature of authorized agent <br /> C)3n 1Z C( �6 <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 Commonwealth of Massachusetts <br /> BARNSTABLE ss / DATE JhL o <br /> Personally appeared before me the above-named \ G 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 fou ears thereafter so ng ass h bus sall be conducted and shall lapse and be void unless so renewed. <br /> Margaret C. San l r� <br /> ° NOTARY pUSUC <br /> o[ ry Public <br /> SEALEOM10 Q N a;-a <br /> `'� l Commission Expires: <br />