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BUSINESS CERTIFICATE#08 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE /U- 3 ,n <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, y <br /> .(,n /� DBA l�l\�I�� i_� Int /�Ylis conducted at <br /> Business Location: C e� l to Sf �U � YY) C�auq e <br /> Business Mailing Address: <br /> �/� t - � � Q- c31 <br /> Business Type: \-7 . Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone:glift <br /> ertify 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 /> Mes as required under law. <br /> *Signature of authorize gent - *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency _ <br /> NAMES( �(� rj 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 D O� D B <br /> Personally appeared before me the above-named 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 ears 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 /> �ed / Y, "Li — — iv <br /> s <br /> SEAL Notary is <br /> COMMONWEALTH OF MASSABHUSETTB <br /> Commt $$16 <br />