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BUSINESS CERTIFICATE#07 �11 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE / <br /> DATE /cp �G <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)'thhata.,business under the title of <br /> /✓CGI E/L.���L.f))U) 11R2ZL� )V%7C)b'15k j /7:/ is conducted at <br /> Business Location: <br /> Business Mailing Address: <br /> Business Type: �C)i�) (� �� i/y,0 "V E Business Telephone: -79 <br /> C SLp'f l� <br /> by the following named persons: N <br /> FULL NAME RESIDENCE <br /> Home Phone: e) <br /> ertiay 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 /> as required and law. <br /> ignatur�o uthorized agentp *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> / 1 In case of emergency <br /> NAME: / (// _ 7 J� TELEPHONE NUMBER:S C)' - <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 /> BARNSTABLE ss <br /> The Commonwealth of Massachusetts n <br /> DATE hoc <br /> Personally appeared before me the above-named '1117 ,/j/n/j/i 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 businelss shall be conducted and shall lapse and be void unles so renewed. <br /> ed h <br /> ? Notary Pu <br /> SEAL` Deborah F. Dami <br /> -- R� NOTARY PUBLIC <br /> Commonwealth of Massachusetts commission Expires: <br /> My Commission Expires July 24,2009 <br />