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1 � <br /> r J BUSINESS CERTIFICATE#07_&�S <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE //// <br /> • DATE y b 6l <br /> Expiration Date: December 31� 2011 . <br /> In conformity withthe provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby declare(s)thata business under the title.of / <br /> k lf�� /`j Z44-"-.0' L <br /> DBA d t A ��j�4r rj is conducted at <br /> Business Location: <br /> Business Mailing Address: / t 0. 2 .t/ 7 `h{�f•/a tLp <br /> Business Type: 2 /-� Business Telephone: 7 e 77 <br /> s <br /> by the following named persons: - - <br /> FULL NAME RESIDENCE <br /> �d �%moi/ �Ci✓,,^+� ^ � f wQ_e.., �'A�'C/�- <br /> Home Phone: <br /> I rtifyunder thepenaltiesoferjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> ,ce es as required dei law. <br /> *Signature' autho ' gent *Signature of authorized agent <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 MassachusettsGeneralLaw,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts � I (( <br /> BARNSTABLE ss DATE v7� r��b-V ( <br /> Personally appeared before me the above-named �• b(�pV� 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 thereafter so long as such pbuiness shall be conducted and shall lapse and be void unless so renewed. <br /> ed <br /> W✓lA l-' VICKEGOVON1 <br /> SEAL _ ft <br /> Commission Expires: <br />