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A" BUSINESS CERTIFICATE #07_�/q <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 declare(s)that a business under the title of <br /> �rXt_="� 09Rel&i(A _lAC DBA OtILf' _9k- k CrR <br /> is conducted at <br /> Business Location: a Cz"TC72 ST12 0 0 a apee fit-{ [ 49 <br /> Business Mailing Address: Sa-VYI.L_ <br /> Business Type: Q n EQ Business Telephone: _ �/��( y7 '7 �QZQ <br /> by the following named persons: <br /> FU' NA RESIDENCE <br /> la R R_n nJe Rc�a� C► sanb c M <br /> CmQmn AD RIL CIL rsan�wi <br /> Home Phone: �)3 <br /> I 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 /> taxes as required under law. <br /> 1Wgnature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: 5Vei ,S3q <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 subiect 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 /> BAR`IST.ABLE ss � DATE S- (G- aQ7� <br /> Personally appeared before me the above-named A"f J[Qn R. Cc,tof01'x and made oath that the foregoing statement is <br /> true. 0 — <br /> A cent mate iss d 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 t ereafte so ng as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • N t Public . <br /> S AL 004yCommission <br /> Margaret C. Santos o l O <br /> NOTARY PUBLIC <br /> Commonwealth of Massachusetts Commission Expires: <br /> Expires Sept.24,2010 <br />