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X/ p <br /> BUSINESS CERTIFICATE#078 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF M.ASHPEE <br /> DATE 20 .0 ? <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 /> SUYrI YY1Br7�PI�C� S�� DBA is conducted at <br /> Business Location: N7©U RelmQS�c:�A,6 M4 . ?(7 _6 tF Q <br /> Business Mailing A!d�dreess: SQkn .e <br /> Business Type:s /)nVSP4 Business Telephone: !69 <br /> by the following named persons: <br /> FUL'I,N RESIDENCE <br /> Z In ra rl'el # e act,- C'a110QY RFs coltdW hU s Qr. . <56S <br /> Clt zoa6e�l' 1�- cm'Wei- los gj 'v7 Aw- <Fas4- -tom142o,4 t, <br /> Home Phone: SOX - 5�, • 63 D <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 /> xes as require er law. / <br /> Sign a of a orized agent *Signature of authorized agent - <br /> Oq iY2 <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 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 MassachusettsGeneralLaw,Chapter 62C,Section 49A. <br /> The Commonwealth of.Massachusetts <br /> BARNSTABLE ss DATE C( 0 <br /> Personally appeared before me the above-named R L i' 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.si/ <br /> ed <br /> _ - Notary Public <br /> SEAL <br /> Commission Expires: <br />