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BUSINESS CERTIFICATE#OF'41 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> -• DATE <br /> Expiration Date: December 31, 2M <br /> '-o ly <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 /> Neil d1111aa✓be,7d Go/F and DBA GIVt //0 " Id Cb-"7 CI-14s conducted at <br /> Cha C/c/6,.Tnc- <br /> BusinessLocation: /30 We//o �/by��l 0te1✓e <br /> Business Mailing Address: M4A,fJee 177451 Oa <br /> Business Type: Business Telephone: S08 S3 9 "SOd� <br /> by the following named persons: - <br /> FULL NAME RESIDENCE <br /> Home Phone: <br /> I certify under the penalties of p jury that I, to the best of my knowledge and belief, have tiled all state tax rentms and paid all state <br /> taxes as required under law <br /> lWignature o 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 fling 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 /> BARNSTABLE ss p , t DATE <br /> QSFJ aCO� <br /> Personal iv appeared before me the above-named l(-OLQ ',��.(v•Q, 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 /> Signed <br /> - Notary public�/uRblic <br /> SEAL <br /> Commission Expires: <br /> j - MICHAELLE MESSIAS <br /> Notary Public <br /> Commomeeallh of Massa busa <br /> ul My Commission Expiree <br /> July26,20.112 ,.:>. <br />