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BUSINESS CERTIFICATE#07 <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 /> �nundersigned hereby declare(s)that a business under the title of <br /> twl �i� �C1t(1�11� t Ir A DBA is conducted at <br /> Business Location: 1p we r�I _k ; U(L� 'M� <br /> Business Mailing Address:S vf& CLS <br /> Business Type: Business Telephone: C5Q2)5 2E� <br /> by the following named persons: - <br /> FULL NAME RESIDENCE <br /> SQan (?,cQ(10�1 Q ' Pc�r� &-&Q <br /> Home Phone:(5 )Lj 19 q Q S" <br /> *certify under the allies of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> xe s required d law. <br /> *Signature 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: <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 Revenueto 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 DATE 3 Z <br /> Personally appeared before me the above-named ,\C.cl— 6, and made oath that the for 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 thereafter so long such business shall be conducted and shall lapse and be void unless s r newed. <br /> �ed —j <br /> eborah F. Dami ' �o� <br /> ' NOTARY PUBLIC11 <br /> SEAL •.� COfninOnWB0l Massachusetts Notary Publi <br /> My Commission Expires Ju11124,2009 <br /> Commission Expires: <br />