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BUSLNESS CERTIFICATE#07 �Iy <br /> J THE COMMONWEALTHOFMASSACHUSETTS I <br /> TOWN OF MASHPEE <br /> DATE ,� a`a- 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 /> — 6 b,0-44:�_5 DBAL.I'��� ��/� e�-,$S is conducted at <br /> Business Location: <br /> Business Mailing Address:_PQ. Rn <br /> Business Type: Business Telephone: <br /> bv the following named persons: <br /> LL SIERESIDENCE <br /> SON y // wv4 �GU/�4, u),opf <br /> Cyt` <br /> Home Phone:JvO - $35-,/ <br /> I certify under the penalties o rjury that I, to.the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes s ie under I <br /> i, a of au rized agent *Signature of authorized agent <br /> * Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NA,NIE: TELEPHONE NFUMBER: <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 tae tiling or car: <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,blassachusetts General Law,Chapter 62C, Section 49A. <br /> The Commonwealth of,11assachusetrs <br /> BARNSTABLE ss DATE I od V <br /> true. <br /> Personally appeared before me the above-named 'k rsa aJ Ph U E-4-0q o <br /> and made oath that the foregoing statement is <br /> A certif issued i e w 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 erect long as su usi a ,ed and shall lapse and be void unless so renewed. <br /> Signed <br /> eqL� <br /> • SEAL _ Notary Public�;q <br /> UT <br /> ��OSEC o%qy wt�e t"e '%i <br /> COMMONWEALTH Oi MASSACHUSETTS <br /> MyCwnmis mExpires <br /> Oct W 25,2913 <br />