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BUSINESS CERTIFICATE.#07K] <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE 7 <br /> DATE �Cc ( O <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 /> n © DBA- 5 LF e r (/ / �iJ I is conducted at <br /> Business Location: ,S j �" o t2zl s' 1"1> r�_ .1 2 . — `'YJ"d P .¢ . 1�1 6-S S o 1Cp �C <br /> nr— <br /> s /' S M � 11. )01c��,.d-sS <br /> Business Mailing Address: J o 2T 1� t((n� /C _ <br /> Business Type:&,vt_f-0 047VL T Business Telephone: S-ok 5 `} C� C7 <br /> by the following named persons: <br /> � FULLrPJi3OME RESIDENCE <br /> Home Phone: <br /> I certify under the penalties of perjury that I, to the best of my knowledge a�lief, have file all state tax returns and paid all state <br /> taxes as required under law. <br /> 'signature of aut tze ent *Signatur of au prized or <br /> 160I — z.LG-6C7 ) <br /> *"Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME:In -y", TELEPHONE NUMBER3ZF �S"^��J_99,gj , <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 /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named f16 and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section shall be in force and ellect 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. <br /> Signed <br /> 'l+u Ste' Notary Public <br /> SEAL <br /> Commission Expires: <br />