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BUSINESS CERTIFICATE#08 <br /> _W <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE I �>'D 1 <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 h eby declare(s)that a business under the title of I /q ��ea co J <br /> \ DBAt A,}l tle,5` ttf (,���� �1 Ag '° I `' i� conducted at <br /> Business Location: S .l am - (cy3 kA r"— 1A <br /> Business Mailing Address: �h ' / <br /> Business Type ��T/i11� Business Telephone: J �' �I�� �O O <br /> by the following named persons: <br /> FULL NAMPVSIDENCE q <br /> /IUNI [ /lyl >7`�J In 0. rA �Nl � <br /> Home Phone: <br /> 0ertify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> es as required under law. <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 BARNSTABLE ss //^^// qct' _ r`� � DATE <br /> Personally appeared before me the above-named l.:-y�'F16 �- tN 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 thereafte o long as such.business shall be conducted and shall lapse and be void unless so renewed. <br /> Ida I <br /> otarj�.Publi <br /> SEAL JOSEPH L.MAllUCCMEW,J <br /> Jets%Aiwe <br /> NMOiRR19�f1'V%fIPr11dSSSACHU9 <br /> My Cannrwron Ezpitee <br /> MOW 25,2P13 <br />