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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 nn �y / <br /> A, A�1l,5`rN�/ �i'�. DBA�i nortl�i �f /� �L is conducted at <br /> Business Location � /1/2xl, m 6 .4 4 /�'f1�ij�e��M d d 7� <br /> Business Mailing Address: s///�"/'a✓ p <br /> Business Type:44l/ ( .Business Telephone: <br /> by the following named persons: <br /> FULL NAME. RESIDENCE <br /> Home Phone: <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 /> es as r aired under law. <br /> gn re of authorized agent *Signature of authorized agent <br /> 30-00 9 G 7.3 zf"� <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: //P rC .�AJ TELEPHONE NUMBER;7�t �Y 7,21 <br /> Alarm Company: <br /> *This license will not be issued unless this certification is signed by applicant <br /> **Your social security number will be famished 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 /> BARNSTABLE ss DATE a <br /> Personally appeared before me the above-named lS � '�� and made oath that the foregoing statement is <br /> true. <br /> A certificate iss ed 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 to rs thereafter s long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed r <br /> J SEPHL AZZUIX�NEW JI <br /> NotW H � <br /> SEAL WMNONVItOEF MASSACM <br /> pty Commission Expires <br />