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BUSINESS CERTIFICATE#07,5 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE .3/9/0 7 <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 /> FAg fA (P F41 K I e S DBA_ rAY1 C is conducted at <br /> Business Location: 0767 GIC Zad,6q. kd A1,o J S0ab R&i4 <br /> Business Mailing Addireess: 7- rrW y - Lkhi t? JF. r/glrn,O(A <br /> Business Type: O Ce,I Business Telephone: S08' ±5-3 i <br /> by the following named persons: <br /> FULL NAME SIDENCE <br /> _� r2�� o To . o C i n vie f I aSTei^ru leu 1ye, <br /> M>4o�s.3� <br /> Home Phone: ,508 - S-q 9--&q 7 e <br /> I certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax rem ms and paid all state <br /> leis aj required under law. <br /> Signature of authorized ggent *Signature of authorized agent <br /> py a33 - DEQ -f aa Ir <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <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 /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE � -3O —Oil <br /> true. u / <br /> Personally appeared before me the above-named LVA"' 5G"f and made oath that the foregoing statement is <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 fo�uears thereafter so long as such busiass shall be conducted and shall lapse and be void unless so renewed. <br /> �i V\ tiNw VANN GOVO M <br /> Notary Publle <br /> COMMONWEALTH OF <br /> SEAL Not JWV 10.2010 <br /> Commission Expires: <br />