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BUSINESS CERTIFICATE#07 R6 • THE COMMONWEALTH OF MASSACHUSETTS TOWN OF M,4SHPEE DATE �–U–2- Expiration Date: December 31, 2011 In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the on st eddhereby declar&)thatt/a bu�sineess under the title of - ` ��_:Ght D13AQ,L9) tj <� — 's conducted at Business Location: d ^Cites JF Business Mailing A,,,,dd .��„� Address: - Business Type:�/�e,'Awa �?� /,,._J Business Telephone: by the following named persons: CJ / FULL NAME q O RESIDENCE Home Phone: oo led'�i ©LzL 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 AftiXes as re uired under law. ti *Stg afoinfauthuedaagcnnt-� *Signature of authorized agent **Social Security Number(Voluntary) -or Federal Identification Number In case of emergency NAME: CY a'�(L'z?�j TELEPHONE NUMBER: Alarm Company:�_gel *This license will not be issued unless this certification is signed by applicant - **Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have mer tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. The Commonwealth ofMassaehusetts BARNSTABLE ss // DATE p /17 Personally appeared before me the above-named �GCOP > hij,y, xbi„a and made oath that the foregoing statement is true. 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 each four years t er s3jqng as such business shall be conducted and shall lapse and be void unless,so renewed. igned �• ee n ' Notary Pu he SEAL Deborah F:_D p NOTARY PUBLIC'- Commonweft of I a&(achuseft Commission Expires: My CommiWonElphes July 24,2009