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BUSINESS CERTIFICATE#07 —,;2O <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <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 /> �Y�le�lt {d�MaJq� DBA QI /�=�/1 1 1. %/���-r is conducted at <br /> Business Location: 35 IC4 l.onr e 'Dr--ryy <br /> Business Mailing Address: <br /> Business Type: % Business Telephone:�S_� 633 —GBG- <br /> by the following named persons: <br /> 1WY� FULLAME^ OI RESIDENCE <br /> nn reTYa <br /> N ie . 1-7 0064�j <br /> Home Phone:h10�) Z/77-79q,5 <br /> *e fy under the penalties of perjury that.110 the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> as required under law. <br /> a� . <br /> *Signature of authorized agent *Signature of authorized agent <br /> 0,31 A <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: A Jn 2 / A_- TELEPHONE NUMBER:0010 53<1 -o85 <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 Citing 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 <br /> Personally appeared before me the above-named TVO Per�elra ale 14 Me'L�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 /> edI(/d9 /a� / /I Margaret C. Santos <br /> rP1/'Q Oe .Win f p ✓ - 1 <br /> NOTARY PUBLIC <br /> Commonwealth of Massachusetts <br /> SEAL <br /> wy Commission Expires Sept.24,2010 otary Public <br /> 0- aK -ID-6) tD <br /> Commission Expires: <br />