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BUSINESS CERTIFICATE#07� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE DATE qSS � &rrYJ�JIQpn <br /> � ��O <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 /> n, I //—DBA Y�It t`� 1 IDIC�t'127 is conducted at <br /> Nb <br /> Business Location: �; 5e-5I�(>� -1Li ocU.i <br /> Business Mailing Address:_ d('.i'\ / L 6c <br /> Business Type: EV11t32b117�jZ\T Business Telephone: <br /> by the[following named persons: <br /> FULL NAME RESIDENCE <br /> i .J - tt-ci(Li \ aosl- kkJ' Shams 13eLICI t(,(C,L; <br /> Home Phone: 5361— <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 /> s as required under law. <br /> *Signature of authorized agent *Signature of authorized agent <br /> ').h-0 0 401 LP S,5 <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 sub meet 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 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 /> -- � rt& JOS7EPHL. ZZUCCHEPubk <br /> Notary Public", SEAL ryFMAn�OF 11R8lf�CX d J' OLission Expireser 25,2013 Commission Expires: <br />