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BUSINESS CERTIFICATE#07 (� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE Q Y/Alh 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 /> Gomer /DBA (,../z/��v,.wt �dno.n� �r.�-tphov�,.�rt�5is conducted at <br /> Business Location: e� L-eO17//4!^ ZZOVLn L/1 Z4n5/,,o << <br /> Business Mailing Address:(SQ m e J <br /> Business Type: ly <br /> _ ome - ", ('Overs en f Business Telephone: �s68)�7 <br /> by the following named persons: <br /> /� FULL NAME RESII)�ENC� / /"�t <br /> J ' ol�G �, 6- r`PQr L <br /> e9 Lza��ir� L eoft h. aSARee <br /> Home Phone: (s0A y7 7 - oe5 e <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 la <br /> *Signature of fKthorized agent *Signature of authorized agent <br /> / S _,� e Y-7 3 SS- <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> 'NAME: r ze! TELEPHONE NUMBER: 5_0(f S2y--18 5 J <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 subiect 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 /> 6.4ItNST.�BLE ss �t/t L /� DATE <br /> Personally appeared before me the above-named / �Ot-F- U-rG2/' and made oath that th 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 yearsthereafter so long as suc business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> C �� <br /> • r Notary Publi <br /> SEAL Deborah F. Dami <br /> Q <br /> NOTARY PUBLIC <br /> Commonwealth of Massachusetts Commission Expires: <br /> My Commission Expires July 24,2009 <br />