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BUSINESS CERTIFICATE#06_$3 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OFMASHPEE <br /> DATE <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 /> �tVl PV-:P (S) is conducted at <br /> Business Location: \2 MA%/ IrlPEG: rn '1 02 l y 9 <br /> Business Mailing Address: SAM � <br /> Business Type:1�)A �c 6 tP}` pw-q Business Telephone:5CR <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> 12YY) A y <br /> Home Phone: Lf a <br /> rfy 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 /> s as required under law. .. <br /> * 1gnature of authorized agent *Signature of authorized agent <br /> ��f trL� Uc',g2 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME ��� �'�J1( �Jll �/.(/� TELEPHONE NUMBER: ?? L4 E3 <br /> Alarm Company: - - <br /> *This license will not be issued unless this certification is signed by applicant <br /> **Your social security number will be famished 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 ofMassachusens <br /> BARNSTABLE ss DATE 1LfaCfJ� <br /> Personally 2ppeared before me the above-named)Rmto-er�e e,'Dt rl!a 2 SS 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 /> -�d p .. .. <br /> garet C. Santos <br /> _`:NOTARY PUBLIC <br /> SEAL Ctimmonweatth 01,,Massachusetts otary Public <br /> My Commission:Fxpires Sept.24,2010 p� a�! 001, 0 <br /> Commission Expires: <br />