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M•` r �/ <br /> BUSINESS CERTIFICATE#07_L7 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> 136 <br /> Expiration Date: December 31, 2011 <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 /> ' c /�iS ioS-cam f T DBA is conducted at <br /> Business Location: 2 1-1c, <br /> Business Mailing Address: / Hioll/h <br /> "y M_ <br /> (j g <br /> � <br /> Business Type: xlc_ /E <br /> ✓rr Business Telephone: /7/7 _/6�) <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone:-_ 5_6� <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 /> taxes as required under law. <br /> 'Signature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency �7 <br /> NAME: S'rti �(l /( .e� TELEPHONE NUMBER: %77p j`/,y <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 t� `�,3(J' Ocp <br /> Personal ly appeared before me the above-named C�i'Q,S f ��Sq� t- 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 /> • Deborah F. Dami "°tea'"y/Publi <br /> ssni " NOTARY PUBLIC <br /> 9pp Commonwealth of Massachusetts <br /> My Commission Expires July 24,2009 Commission expires: <br />