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BUSINESS CERTIFICATE#07 // <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <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 /> It <br /> DBA /-'-�(/� A � �jty � conducted at <br /> Business Location: p2 'CI (1 ee ( I 2!J 42 ✓I �„) '��n Y (� <br /> Business Mailing Address:T,or 1(7 '792 05 ke a U , <br /> Business Type: SeASvn 1 HSS Business Telephone: 777 031p Q <br /> by the following named persons: <br /> FULL NAivIE RESIDENCE <br /> �o �t ��a �t l�� >Lf �Z 1 i V Z <br /> `/ pp� / <br /> Home Phone: 777 g3& �a�( <br /> I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> t <br /> rider law. <br /> QLi.dniaT:�7,F3 <br /> d agen[ •ytomature of authorized agznt <br /> -'Social security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergencv <br /> NAME: TELEPHONE NUMBERLL �-yQ ZD G 1J <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 tar riling or tax <br /> payment obligations. Licensees who fail to correct their non-f ling or delinquency will be subiectto license suspension or revocation. This request <br /> is made under the aurhority of.Massachusetts General Law, Chapter 62C. Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARYSTABLE ss _ / 7 DATE / D <br /> Personally appeared before me the above-named 11t)�//1) l3 /k12C'L and made oath that the foregoing statement is <br /> true. <br /> A It, rca ued in a cordanc with this section.sha be in force and effect for four years from the date of issue and shall be renewed <br /> rn,'o <br /> years thereafter- long s such w'ss <br /> shall be c nd ted a - and be void unless so renewed. <br /> ` - /1 <br /> Q <br /> I "~ <br /> .. <br /> SEAL Notary P lic . <br /> WJConvu*ftfAxpires: <br /> CONNONWEALTH OF W188ACH <br /> MjCOmm==EOU <br /> Oclatip 18 <br />