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vt. <br /> BUSINESS CERTIFICATE# 07 -;l <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE l0 S2 )4 <br /> 10 <br /> Date: December 31, 201 j <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 / �[ /� y� Lr p <br /> L "' a 50-17Q `,'t DBA 1, ^_P I A /'?Q P l) S17t/) is conducted at <br /> Business Location: __�p,19 @ a„ [-( k15 L*X <br /> Business Mailing Address: _ S`oiYat P <br /> Business Type: S" O_<� ROd Tk Business Telephone: �j ZsFC - <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> —fiz? 5r� ti92 AZ C a l{9 <br /> Home Phone... 5'0 <br /> I certify under the penalties of perjury that 1, 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 /> � <br /> J Pga-j St�Olt�p <br /> gnature of authorized ag6nt `Signature of authorized agent <br /> Oa9 — )a - 0566 <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency L <br /> NAME: �8I g �2Sc_)? at TELEPHONE NUMBER:J O8 <br /> *This license will not be issued unless this certification is signed by applicant <br /> "Your social security number will be fumished 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 subiect to licensesuspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts � pp <br /> BARNSTABLE ss DATE C1t Ill�9 ec N BOO(' <br /> 7 II �� � T <br /> Personally appeared before me the above-named a F' k LO i S (OL4 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 /> • SEAL. Margaret.C. Santos tarrPublic <br /> ]t, NOTARY PUBLIC Q- al(- ao I <br /> P\ d <br /> 0,�r CommonwealKoi Massachusetts Commission Expires: <br /> Y'Y <br /> Viz. Wy Commission Expires Sept.24,2010 <br />