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BUSINESS CERTIFICATE#079� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE• /DATE ��S/O 7 <br /> —T 7' <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 /> C✓1,1/6,65 DBA is conducted at <br /> Business Location: j/ c Y1`/�/�rF®2D 1/04ff .446 <br /> (¢Q <br /> Business Mailing Address: /I %./�/f' F- de /47As--vAfe M� 67&Q y <br /> Business Type: /10A/7E SE/c'1!/CE_S Business Telephone: Sae — 2 74/ — 4Z ?4 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> /►O/a.QY M• ✓'E.t/E.e/ // �ST2ATFnn/ID i7��r� MAS/lPE� .t/l,4 02�¢f• <br /> Home Phone: <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 /> tagles as required u Ider 1 w./ <br /> tgnatur t authorized agent *Signature of authorized agent <br /> U <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> 3/SAlNAME: ✓ER/Ei2/ TELEPHONE NUMBER: 774 —238 931,6- <br /> Alarm <br /> arm 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 49A. - <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named J �-Ak\\ \a � and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section shall be in force andeffect 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 /> VICKI ANN GOVONI <br /> jr&• - - Nottvv P;'.�uc <br /> ota <br /> SEAL fission Expires <br /> - 19.2013 <br /> Commission Expires: <br />