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BUSINESS CERTIFICATE#07_L3 <br /> THE COMMONWEAL TH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE 2R / <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 /> ltd vILyr ' __DBA s conducted at <br /> Business Location: �5 (,Ja d-e r (�C� I-1 M� �pR ain n w y y <br /> Business Mailing Address: �.(� • 60 X 7 2 1 IYlc�e 1� p , `1� 0-ZG( V I <br /> Business Type:��1� j J a-y Ea�-ir � �� Business Telephone: -]'N—f�'3� — Q�y Z] <br /> by the following named persons: <br /> _ r_FULL NAME''II, t Ip RESIDENCE <br /> 20 f) M <br /> "iii M,9 6.26 Ute_ <br /> Home Phone: .0569-539 I Z J(o <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 required under law. <br /> i <br /> gnature of orized 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 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 49.A. - <br /> The Commonwealth of ilfassachasetts <br /> BARNSTABLE ss I DATE (3 O6`' <br /> !J Personally appeared before me the above-named re"64919A fJ�&"ele f 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 after so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed. <br /> • Notary Publi <br /> SEAL c <br /> JOS <br /> Notary <br /> COMMONWEALTH ComN as Expms USETf6 <br /> My Commit Expires <br /> /NS <br /> polober 29 2019 <br />