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` BUSINESS CERTIFICATE#08_::_Yh <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE -C-T(-, <br /> - Expiration Date: 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 declaie(s) that a business under the tide of <br /> ,- ' `- CQ. -,� Cy. DBA M is conducted at <br /> Business Location: <br /> Business Mailing Address: `sf- � - `( <br /> Business Type: Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESI ENC " u <br /> Home Phone: <br /> certify under the penalties of perjury that I, Co the best of my knowledge and belief,have filed all state tax returns and paid all state <br /> es as required under law. <br /> �. cCQ X00 &40� <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 :�Ca.E� 6\e vne n'� 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 lloon/g� as such business shall be conducted and shall lapse and be void unless so renewed. <br /> �ned <br /> 1 t7� <br /> Notary Public <br /> SEAL Margaret <br /> WVY <br /> 9 C. Santos 9-d(/- XI bNOTARY PUBLIC Commission Expires:Commonwealth of Massachusetts <br /> Commission Expires Sept.24,2010 <br />