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BUSINESS CERTIFICATE#07 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE i N,�>, ZOo7 <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 /> tACS�e CS Qco c a r�xe s��t �ai�nrl�n'b DBA QC uV�Ltt �Oc�n e e\� m m{llais conducted at <br /> Business Location: �fw6�_(J�l <br /> Business Mailing Address: 3o X 1 (I6�n �e e t m l� O Flo 6 <br /> Business Type: Mtr�e Business Telephone: - 1;p R- • y1`1 • yy�(� <br /> by the following named persons: <br /> FULL NAME RESIDENCE p <br /> �Ce vy\ �n Ma�s�ers 1"l `3�" s�wY� NZOC . M0'9\r\_Aee4oai.Lt <br /> Home Phone: 0309- 41`7• b1 a to <br /> ANILcertify under the penalVies of perjury that I, to the best of my knowledge and belief, have filed all statetax returns and paid all state <br /> es ased unde aw. <br /> jA ,e <br /> *Signature of authorized.agent *Signature of authorized agent <br /> 0 L-1 <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 fumisbed to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who failto 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 �S t-6\ zeo7 <br /> Personally appeared before me the above-named )Ley nC \�\OLMNeCS - 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 /> ed <br /> Notary Public <br /> SEAL <br /> - Commission Expires: <br />