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BUSINESS CERTIFICATE#08 V <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <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 _ ___t <br /> fd <br /> c,y.5 t4. 1 Pty rl"c kl pp DBA (L_`1©(.�. :V ����s is conducted at <br /> `4ar <br /> Business Location: <br /> / ' / ✓ e)Qlzl/l son 's / <br /> Business Mailing Address: 1 / 3 l oq66p7lS JA4, -11 Q & <br /> I <br /> Business Type: A4_I � � f' Business Telephone: We-1— 2 <br /> by the following named persons: <br /> FULL ME RE DENCE <br /> Ma. s a��aCv�eks . 0�/3 -d czm �soh 's <br /> Home Phone: <br /> rtify under the penalties of perjury tha I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> s as required under <br /> *Si nature of au oiiz d agent *Signature of authorized agent - <br /> O l N- 64- 13310 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: /t/Qy t 1&N doV ceS 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 con ect their non-filing or delinquency will be subject to license susuension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts h <br /> BARNSTABLE ss ��J /� //� DATE <br /> Personally appeared before me the above-named l-[z,Zl -&t 5 T/- na4,ii4 S and made oath that the f egoing statement is <br /> true. t <br /> A certificate issued in accordance with this section shall be in force and effect for four years f om the date of issue and shall be renewed <br /> each fow years thereafter so long as such business a be conducted and shall lapse and be void unless so renewed. <br /> 0e <br /> Deborah F. Dami <br /> k�� <br /> NOTARY PUBLICCNO Notary Pu lie <br /> SEAL Commonwealth of Massachusetts <br /> My Commission Expires July 24,2009 <br /> Commission Expires: <br />