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BUSINESS CERTIFICATE#07. <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE j cit iU <br /> Expiration Date: DeceinbaX 31, 2011 <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> uriltrNried here�by d�eclare(s)that a business under the title of <br /> �1V , 1..reT - - -- - <br /> 1'1- <br /> / (.l r- n ' �((�(.¢,n DBA is conducted at <br /> Business Location: 4-r, <br /> -P /a/,l (� [o�b t y�I/I�n <br /> Business Mailing Address: [L�.0 pL; S' a 4-r , __r_ AA - <br /> S I— NIn 1 D - (), <br /> Business Type:��S I — 7'fnC��A C+roi., t 0U1;e�Business Telephone:_ �`�(j�— , fig —&cZCL,� <br /> by the following named persons: o <br /> FULL N RESIDENCE / <br /> � UP� « �. 17tV ��� ( lLI Se �c. e /�4LtQ_ yf� ._A4 <br /> NA <br /> t 1, q <br /> Home Phone: �?� `a! 7-12 -ate g/ Cr t Je-+C- /7(k M b-'(. _ <br /> certify under the penalties of perjury that I, to the best of my knowledgeand belief, have filed all state tax returns and paid all state <br /> es as required under law. . <br /> '!!! <br /> Signator of au ortzed agent authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> qq In case of emergency <br /> NAME /`l) A `p j 1 ty (LQ�2 r TELEPHONE NUMBER: <br /> Alarm Company: <br /> *This license will not be issued finless this certification is signed by applicant - - <br /> "Your social security number will be furnished to the Massachusetts Deparnnent 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 MassachusettsGeneralLaw,Chapter 62C,Section 49A. <br /> The Commonwealth ofMassachuietts <br /> BA RNSTABLE ss DATE <br /> Personally appeared before me the above-named A A and made oath that the foregoing statement is <br /> true. , <br /> I <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 yea thereafter so to - uch business shall be conducted and shall lapse and be void unless so renewed. - <br /> ed A <br /> �A Deborah F. Da Not Pu ,e <br /> SEAL NOTARY PUBLIC <br /> Commonwealth of Massachuse++s <br /> - _ My Commission Expires July 24,2009- Commission Expires: <br /> , r <br />