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t w <br /> BUSINESS CERTIFICATE#06 —6 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE () <br /> DATE J 1.2j/IO(/ <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 /> Kt, _Lr,1)61- ITt nV DBA KK F/'rejs <br /> is conducted at <br /> Business Location:_ fir' 06t�f / <br /> Business Mailing Address: ob)l e / ,3 44.11zr /4/wi XM&I <br /> I �I(7i(r!I��QPt° <br /> Business Type: ✓" ` f"jL1yal /1l/'/U] Business Telephone: V .27U0 <br /> by the following named persons: / <br /> FULL NAME RESIDENCE <br /> Home Phone: <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 /> x�es�as��required under law. _ <br /> *Signature of authorized agent . <br /> Signature of authorized agent <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 afMassachusetts <br /> BARNSTABLE ss DATE Q'dG6 <br /> Personally appeared before me the above-named .e o h S{'f1 rl 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 or 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 /> �ed v -GLS ��D�to/Z�L Santos <br /> aret C. <br /> n - N07ARY PUBLIC S <br /> SEAL .COmmall`Netlllh�01 Nlas�t„24 2010 / Notary Public <br /> Ny Commission Expires SeD <br /> �-a4-aoib <br /> Commission Expires: <br />