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BUSINESS CERTIFICATE#075 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE I 0 <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 de�claa�re((ss)�that a business under the title of <br /> ll VST LA 666-5 Ltk — DBA is conducted at <br /> Business Location: 17 PP(e !/`z4n--_� d Zb�9 <br /> Business Mailing Address: 0 f O, 076 <br /> Business Type: IYWr162PA/f(JK7*Mr ' Business Telephone: J 77- 7560 <br /> by the following named persons: <br /> FULL NAME RESIDENCE q <br /> �L > <br /> --of L7 1P,!)P?111 <br /> Home Phone:=J�0/ y / 7— <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 /> xes as required under law. <br /> A � o <br /> _ Signsture of authorized agent *Signature of authorized agent <br /> r�0 - 9�61 39S-7 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> 'n w,r'' � �y / C In case of emergency rf}Q <br /> NAME: )'XA1V,- C. ( ODS TELEPHONENUMBER(✓D �0 <br /> Alarm Company: C.� c z A&W <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 /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named'ga t,�g. -k EM�etn (;ODke 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 thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed �`L�� -- VICKI ANNGOVONI <br /> • Notary Public <br /> �r«-er-wssnutua <br /> SEAL otAW�on�� <br /> 19.2019 <br /> - Commission Expires: <br />