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t BUS I\ESS CERTIFICATE#07 -Or- <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE ( b <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 �Nr)v�RG fN PER d' <br /> 11-Rvvd <br /> YaA tA RPNY DBA /q AflYRN•✓PV]2Pt4Y,V/?0 �t�,tc /NAN� rcoNsu/T��T <br /> is conducted at <br /> Business Location: <br /> Business Mailing Address: '`j -Fg/fcy �iF�✓t /1l�SyP�E— <br /> Business Type: 6 &Qr-ESS[6A/4 Z- &K Business Telephone: :Eox y-Z <br /> by the following named persons: <br /> /�� <br /> FULL NAME RESIDENCE <br /> / (lle YAnzn/ ult�i'KY S 3 ��ACY L ANS /�1�F SNPr HomePhone: �-C)K J✓�q - �a y <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 stare <br /> txes as=required law. <br /> Ask <br /> ignature of a th rized ag *Signature of authorized agent <br /> q -D9SV <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> '/ In case of emergency <br /> NAME: �/f.✓ /( [ pre- It A-it/ TELEPHONE NUMBER: 6 /7 7" 9/`I <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 49A. <br /> The Commonwealth ofAlassachasetts <br /> BARIYST.=IBLE ss �//�' DATE '-7/12o <br /> Personally appeared before me the above-named�/(�f}/VA1 t u RPNY and made oath that the foregoing statement is <br /> nue. <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the date of issu nd shall be renewed <br /> each four years thereafter so long as such <br /> ^business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed \\\rte X <br /> • Margaret C. Santos <br /> 2� NOTARY PUBLIC / Notary Public <br /> SEAL Commonwealth of Massachusetts I (� <br /> _ Ny Commission Expires Sept.24,2010 <br /> Commission Expires: <br />