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BUSINESS CERTIFICATE N 08 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE ` <br /> DATEW <br /> Expiration Date: December 31, 2012 <br /> hi 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 /> DBA ,( �{,Q/ -(//�.Yl 1\4 P �" is conducted at <br /> —Business Location:h�� <br /> Il t <br /> Business Mailing Address: t <br /> Business Type: G'3'l Business Telephone: <br /> by the following named persons: <br /> n FUL�y'NAME RESI NCE <br /> to t t rw L-4- cn( 1A e, <br /> Home Phone: (s 0 <br /> ertify under thepenalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> es as requ �u Ider] <br /> *Sig attire of authorized ent *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 ry0 „t <br /> BARNSTABLE ss DATE K Y <br /> Personally appeared before me the above-named ` 4yJ �i A— 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 bus less shall be conducted and shall lapse and be void unless so renewed. <br /> 0ed u G <br /> SEAL JOSEPH L.MA =res <br /> Notary <br /> 0 <br /> UM <br /> mnus <br /> October <br />