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BUSINESS CERTIFICATE#07 oZ� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE f <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 /> 1-4tCA CIrS+ 12e{4Q� t ok, DBA H2G E11tIrS� l l..t 'OPrgC <br /> / o ll is conducted at <br /> Business Location: /C)& FG, {Vx o'u..L-�. e d , n j A 02—&gq <br /> Business Mailing Address: <br /> Business Type: C1 i! P"C+t c Business Telephone: 5,6T 3 fo2^a-q I-S <br /> by the following named persons: - <br /> F�L NAME RESIDENCE n tI <br /> �S k U.G_ L( � 1� G U �t--3 Q 6b c... 6rs+.e !< 6 a <br /> 0"l to c+ �'t-tG 02G 3 5 <br /> Home Phone: <br /> Oc,e rtify under the penaltisofperjurythat I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> esaa <br /> ed agent *Signature of authorized agent <br /> Zp -- 40 1 07 "! 0 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> LL In case of emergency <br /> y t� 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 � 7� <br /> Personally appeared before me the above-named 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 hereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> ned <br /> Notary ubli <br /> SEAL <br /> y�13 <br /> Commis on Expires: <br />