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Y <br /> BUSINESS CERTIFICATE#07-/4 <br /> c <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE J/ <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 /> (LL C l`VCZA 0 <br /> L/j 2to� J1 ijJ2i_� Co^I DBA'�PC 'TS 0 6_0 is conducted at <br /> Business Location: [(o <br /> Business Mailing Address: S/^a1G <br /> Business Type: (�)N U Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> JA_-- l w t 1"c*ylid( -y1,1w2,c,LU It UAS <br /> 9IGtWr;--(2 <br /> Home Phone: CSB 47-.2-3-73 <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 /> e as r quire dud law. <br /> *Sig o u rued agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number - <br /> In case of emergency <br /> NAME: )t9 ea /kl Ni17 u , TELEPHONE NUMBER:6e 1-2)_ <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 of Massachusetts <br /> BARNSTABLE ss DATE 30F Z <br /> Personally appeared before me the above-named pt=1 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,ve s the eaft 9so lou as such business shall be conducted and shall lapse and be void unless so renewed. <br /> mcd <br /> Deborah F. Daeni — <br /> Q NOTARY PUBLIC: <br /> SEAL <br /> V commonwealtfi,ot Massachusetts Votary Public <br /> My Commission E>cpires.July 24,2009. <br /> Commission Expires: <br />