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BUSINESS CERTIFICATE#07f/ <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE II <br /> DATE <br /> Expiration Date: December 31, 2011 <br /> In conformity with the provisions of Chapter one hundred arid ten, Section five of the General Laws, as amended, the <br /> undersigned hereby\decl(arree(s)thhat�a business under the title of <br /> -\Nm _ i\w\ C\�T c" - DBA is conducted at <br /> Business Location:5 NZ( �, AC"— -Z�E +M CA V= m /XAnA OZ.Ce`'c? <br /> Business Mailing Address: �Z ©Z(.Q 0 f <br /> Business Type: Business Te ephol - Q <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> 1�rxAn '�r��teC �El CD <br /> �Gcs�Llue� \ ILA.riL��S ��trl o �( CJ Ca <br /> Home Phone: <br /> rtify 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 /> as qutre der law. <br /> *Signature of authorized agent *Sigire of authorized agent <br /> **Social Security Number(Voluntary) - <br /> or Federal Identification Number <br /> (� In case of emergency <br /> NAMETELEPHONE NUMBER: '1 Q- yU L/ <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 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 D,, J DATE <br /> Personally appeared before me the above-name'm Up t+ / /OAf ICL si- Qt and made oath that the foregoing statement is <br /> [rue. 7 <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 fourears thereafJecse..t as such business shall be conducted and shall lapse and be void unless so renewed. <br /> eu <br /> yrI -1 t+W Notary Public <br /> AL VJ JOSEPH L. <br /> W <br /> maG6WWfkP 6Husena <br /> -My Commission Expires <br /> Och%025,2013 <br />