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♦J - _ __ 1 <br /> BUSINESS-CERTIFICATE#OS <br />--------- THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Dace: December 31, 2012 <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 <br /> ,under the title of <br /> �(z cab Be(--A1 n(q P(-o 1 sit'rtz P AA y DBA is conducted at <br /> Business Location: <br /> Business Mailing Address: <br /> Business Type: fQrl� Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Scc.raht nq a-0 gag "e�y� Dc, Mask p-e_( <br /> Home Phone: (6CZ)4 —H-REC)ertify 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 /> es as required under law. <br /> *Signature of authorized agent *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 Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named "T"tT ��� rhi and made oath that[he forego ng statement is <br /> true. <br /> A certificate issued in accordance with this section shall be in force and effect for Ir years from the date of issue and shall be renewed <br /> each four years thereafter so long a/s�such <br /> �business shall be conducted and shall lapse and be void unless so renewed. <br /> ned aa (�illAl.A/,/! U,k11'�C`h <br /> r^sd ��J� ' J714ma <br /> SEAL Q�l,I`t`\` _kMl_r.'/�/�lyles: <br />