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BUSINESS CERTIFICATE#07 0-4� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE• (DATE Qg131/0—] <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 /> 1"I `#" fl J I?Ak&]S PM-r '1 ^ DBA <br /> yy� c /� is conducted at <br /> Business Location: 53QF�DWDE)1-f0 1ZD . yyr�•�,1�� f�p(�PSO& I�F-Y . 07�rAY9 <br /> Business Mailing Address: f - 0 • F7�yC 2—H 3 E t t pf5 i'lI riy ma .''r02—&LIp. I <br /> Business Type:hn :RftN19e6 ki Business Telephone: <br /> by the following named persons: <br /> FULL NAMERESIDENCE <br /> RWDIJ i o 0.oA &MNi-n tJ o fflo wibo S r-A nI�re�cJ L t J • C 1rrgt4Pf£• ynAk. ozbL(9 <br /> Home Phone: •��g' �7'3003 <br /> ertify under the penalties of perjury that I, to the best of my knowledge d belief, have filed all state tax returns and paid all state <br /> s as required under law. <br /> C• / "y°` — <br /> *Signature of authorized agent *Signature of horized agent <br /> 6 4 --M"t 114 16 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number - <br /> vy1 , In case of emergency <br /> NAME��CL �/f t r 0i{?F �S o TELEPHONE NUMBER: <br /> .Alarm Company: N1o�e <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 /> B.4RNSTABLE ss DATE ql& Lo <br /> Personally appeared before me the above-named 0A-lD&nd made oath that the foregoing statement is <br /> true. <br /> A certificate is ed in accordance with this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> eachfour a rs tberea r s long as suc usiness shall be conducted and shall lapse and be void unless so renewed. <br /> 40 <br /> otary u'� <br /> SEAL COMMONWEALTH MASSACHUSEitt <br /> 'my COMM. <br /> Commissi *13 <br />