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BUSINESS CERTIFICATE#0J3 — '__- <br /> THE COMMONWEAL TH OF MASSACHUSETTS-- <br /> TOWN OF f7ASHPEE �+ <br /> _ - ---- - DATE <br /> • Expiration Date: December 31,4011-4 <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amen 1th <br /> undersigned hereby declare(s) that business under the title of e� <br /> Sj,, jdS 1'V. Mc i k.c kjodkrS DBA J e IfD $ fNZZt <br /> t (� is conducted at <br /> BusinessLocation:ol-s al apt 2. Vf t V-'- w¢w sem )p JI y <br /> Business Mailing Address: <br /> Business Type: Business Telephone: 01 —LI 737 <br /> by the following named persons: <br /> S.L FU�j�,N( Ar IE c( RESIDENC <br /> 1E � ltlS U lar�RhlO ✓tcf (ps �`chRrLVsc $._c) <br /> { o✓�`, t /t/t�1 02 1/7 Y <br /> Home Phone: <br /> I cemfv 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 /> �taxes <br /> as re cited�under law. <br /> TT7C//,✓I� T� <br /> gnatu . of authorized agent "Signature of authorized agent <br /> "*Social Security Number(Voluntary) <br /> or Federal Identification Number - <br /> In case of emergency <br /> TELEPHONENUNIBER: 40-77S- i( /V <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 btassachusetts Departmenr of Revenue to determine whether you have met tar tiling or tai <br /> payment obligations. Licensees who fail to correct their non-sling or delinquencv will be subject to license suspension or revocation. This request <br /> is made under the authority of;btassachuserts General Law,Chapter 62C. Section 49A. <br /> The Commonwealth ofAfassachuserts <br /> BARNST.4BLE ss DATE C� U <br /> Personally appeared before me the above-named Sia?-LIDS gA'2.k A'NT e A.)l S 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 /> ach four Years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> �igned <br /> • Notary Public <br /> SEAL <br /> ommrspj�y�typifes: <br /> COMMONWEALTH Comes OF MASSACHUSETTS <br /> MY Commission Expires <br /> CrdobtM 25,2013 <br />