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BUSINESS CERTIFICATE#07 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE // <br /> DATE f(�F�6Q/U <br /> • Expiration Dare: 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 /> I*'GKPSR /nRniAItFl1AYl DBX��R bMjr is conducted at <br /> Business Location:-./ fie! R 0Y7F}�f)62-' (� P�� trn a�.4!. <br /> Business Mailing Address:— L> 1_ QX 1.40 <br /> 0 <br /> Business Type: LE (TIP bLDWJO- , Business Telephone: <br /> by the following named persons: <br /> FULL NArME RESIDENCE <br /> 1 HdAE-5d h7UA1 1 !1(2L LAt-) <br /> Home Phone: <br /> I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have tiled all state tax returns and paid all state <br /> taxes as required under law. <br /> CL,.&re of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME:-06ui-' It 1 TELEPHONE NUMBER: Z 51 t/ 9/ 76 <br /> Alarm Company: <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 /> BARNSTABLE ss <br /> The Commonwealth of Massachusetts <br /> DATE <br /> true. <br /> Personally appeared before me the above-named "dnd made oath that the foregoing statement is <br /> i <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 sir ess shall be conducted and shall lapse and be void unless so renewed: <br /> Signed - <br /> • .� <br /> SEAL Notary Public <br /> Qx.0 Eit)I,NeGOVONl <br /> W <br /> Notary PuUbc <br /> COMMONWEALTX OFMASSACHUSETTS MY comrtlifieipn Fjtpires <br /> July 78,�t3 <br />