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BUSINESS CERTIFICATE#07� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <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 declares)that a business under the title of qq � <br /> ��t✓-e'er �rr (� 0 U1 V l A DBA IV 0vA)a_er'j'j✓ytofAVP m Prr is conducted at <br /> Business Location: l f C h W 1,4 Ul aR S p Pj t-4 02 t'e 9 <br /> Business Mailing Address: s k}yt-f e__ <br /> Business Type: Av n e,✓V 2 Business Telephone: S 0 S r7 3 9 0606 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> G A- U V V\ <br /> Home Phone:.dMi <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 /> required u er law. <br /> 7g/nature f authorize agent *Signature of authorized agent <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 tar 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 <br /> Personally appeared before me the above-named D-=�\� &Os_p\1�v" and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section shalt 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 bus ess shall be conducted and shall lapse and be void unless so renewed. <br /> VICK4ANN GCONONI <br /> — - Notary Public <br /> SEAL. . o EVIres <br /> jib 1%2019 <br /> Commission Expires: <br />