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BUSINESS CERTIFICATE#0715 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE ►'Z �1 � OCA <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 /> is conducted at <br /> Business Location:_--�4j <br /> Business Mailing Address: (7 , �j pX I {S 1 M�s— h2P o r(M Or 0e)-(OLA { <br /> Business Type:�or�S ( � r o n Business Telephone: Spm- y I1 - I �Z► <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> 'Pc'_� C-1 �o�n1-tea �d <br /> Home Phone: 5c� - f.:i7n _79A-2-1 <br /> 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 /> quired under law. <br /> 6ou <br /> 11�gpnatuirc of auth 'z nt *Sigiatun 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 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 \\ �(7J (� DATE = <br /> Personally appeared before me the above-name��\ l.. \meq� '� and made oath that the foregoing statement is <br /> [rue <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 /> VICKI AN— N— GO ON <br /> Public <br /> COMMONWEALTH OF MASSACMUBETT$ <br /> SEAL Notary N"(19,2013 <br /> Commission Expires: <br />