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BUSINESS CERTIFICATE ti 08 'fo/ <br /> • THE COMMONWEALTH OF MASSACHUSETTS / <br /> TOWN OF MASHPEE DATE g( k (2008 <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 declare(s)that a business under the title of <br /> L W f n �An �l r-0 DBA ,, 5 5k is conducted at <br /> Business Location: M ika_"` t 4L_ 9 ir,e p•! AAA gP( 2e /L4 4 <br /> Business Mailing Address: 1 1 9 It Grx all d cl� � c2,� � /J C <br /> dr <br /> Business Type: fes-0� $Z r Vi Ce Business Telephone: <br /> by the following named persons: <br /> FULL NAMESID1ENCE <br /> Lvt/`crt �°rwr:l-i 1lX1 ,��ttEE, ST.221.e I"retrlc � <br /> 9 (-)u—,to 41 fl , C <br /> Home Phone: <br /> •I certify 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 as required under law. <br /> . ( <br /> *Signature of authorized agent *Signature of authorized agent <br /> ,5b - 2t765315 <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 fumished 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,Cha ter 62C,Sec n 49A. <br /> �✓l¢r 1< loMbv� 7,'A e o N� +h Cuero 1 r 6t <br /> BMMST TM ss �/ / DATE g— — 0 <br /> Personally appeared before me the above-named /t I CLD don 5 {�V 0.hA 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 /> • <br /> t . <br /> I—"w VA"�ot <br /> Notary Public <br /> SEAL <br /> 3 - nolo <br /> Commission Expires: <br />