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BUSINESS CERTIFICATE M 07-621 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE 1 3 -19->3GOlj <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 /> Z-014N RA)C7a£w5 DBA 6vJ's !> rTt2S is conducted at <br /> Business Location: <br /> Business Mailing Address: %0 »/Gfy Z mu Tj 15r /h A5 At P!d 'W p Z a y/4 _ <br /> Business Type: CONsrRUerJOAJ Business Telephone: SOY 'L9Z • /9(, / <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> S0 <br /> 14N <br /> 6u-S </o NJGHZ9AJb S7. JnHsHArr ,nq <br /> Home Phone: 7q- yqo <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 /> Des 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 <br /> NAME: TOAW A L)kf t d S 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 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 I ,} - lit - apOt<, <br /> true. t, <br /> Personally appeared before me the above-named J �n 1c'rna.t e WS and made oath that the foregoing statement is <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 year ereafter so Ione s such business shall be conducted and shall lapse and be void unless so renewed. <br /> ned / <br /> i Margarei <br /> c <br /> SEAL C. tier?,os <br /> UCNotary Public <br /> � NOTARY PUBLIC <br /> Commonwealth of Massachusetts aG (D <br /> Ny Commission Expires Sept.24,2010 Commission Expires: <br />