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c BUSINESS CERTIFICATE #07� 3 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE _ /0,/5__/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 <br /> /hereby deciare(s) that a business under the title of / <br /> DBA L ' �' d1. t ",r is conducted at <br /> Business Location: I /Y o �l '� / r'u�K`P / 7% / /tiS hY�a v A4 Od 61/ / <br /> Business Mailing Address:n <br /> Business Type: /`P�H% , c�w Business Telephone: ��S y T) — 77 S �6 <br /> by the following named persons: <br /> FULL� NAMF, R�SIDEPJCE�ixt l7.tr 4 a Mosw.za bxi Ln // !w Zh, 94 <br /> �Ic�ra(d ��rruh� lam? l/x/ia/1�umrnv/G� �Sl'�wch � <br /> Home Phone: <br /> I certify un the p nalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state. <br /> xes as re it u er law. <br /> 1i <br /> I re of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) _ <br /> or Federal Identification Number <br /> p / In case of emergency <br /> NAME: De" / y v*s hg TELEPHONE NUMBER: S0,9 - V-4-71 ,x 3 <br /> Alarm Company: nark,r <br /> *This license will not be issued unless this certification is signed by applicant <br /> **Your socia! secunry number will be furnished to the Nlassachuscus 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 NI- V1{ S�9.L and 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 t Ireaficr so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> �.n <br /> • n Edi kr <br /> SARAH LYNN JOY HOTCHK No Pub is <br /> SEAL. _ NOINY Pt&lic <br /> w <br /> rrolvWF�►rNawnselax <br /> MYCotraftWmEvirm <br /> Commission Expires: <br /> mKo 7,1014 <br />