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BUSNESS CERTIFICATE 9 07_�Q <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE _ T —/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 abusiness under the title of t <br /> 1`� IJ d=f YIY�AK I� DBAD Or{!� X11yW �Gp �(Q"� is conducted at <br /> Business Location: 1 <br /> Business Mailing Address: e -1) <br /> Business Type:Anl,glwn, <rzljenh tlaa Business Telephone: SOS- q/7` 7/03 <br /> by the following named persons: <br /> FULL VAMP RESIDENCE <br /> �ar�l M� rm�c k -r fYn/e j,�—pr, fN4 <br /> W , MPI X649 <br /> Home Phone:"— 477— 7103 <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 /> taxes as required der law. <br /> n , <br /> gnature dfa6thoriziid <br /> raggent *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 fumished 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 /> BARVSTABLE ss \ DATE ObC� <br /> Personally appeared before me the above-named � <_ `LA 'e'c. � nd made oath that the foregoing 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 as such business shall be conducted and shall lapse and be void unless so renewed. <br /> — <br /> N VI' ANN OOVONI <br /> tJMaty Public <br /> romvur. '.ALTH OF MASSACHUSETTS <br /> • - Notary P 1S.2D13 <br /> SEAL <br /> Commission Expires: <br />