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BUSINESS CERTIFICATE#08�7 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE I U 16)�1 I'1y <br /> DATE d J1 UQ <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 C . <br /> business under the title of <br /> 5 u j � ) L LC . DBA Sl�l is conducted at <br /> Business Location: L J 1' ((( �( L V,��J� / p��(ry� I' u/j QQ / t • yMqq <br /> � <br /> Business Mailing Address: (IIdIIn,�''`` //dd�����//��r''^^J U" �L1rII �.7j1If'C�' lMlrT,/ �OlU <br /> Business Type: Y�u L "l N I V W I Lt�i Business Telephone: So g '"�u q to gU <br /> by the following named persons: <br /> FULL NAM L t �Jz q y) Mom <br /> RESIDENCE <br /> gl65fduiIIfflft, <br /> Home Phone: �W A I A WO <br /> Aakertify 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 /> es as required u er law. <br /> *Signature Wizcd agent *Signature of authorized agent <br /> ao <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: �/t I lN1 I J I I Y f L TELEPHONE NUMBER:-7 7 / ✓�'✓ �y <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 . l <br /> BARNSTABLE ss DATE �'^'��'3 lQJQ� <br /> Personally appeared before me the above-named and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordancewith this section shall be in force and effect for four years fiom the date of issue and shall be renewed <br /> each four years thereafter ng as such business shall be conducted and shall lapse and be void unless so renewed. <br /> �e <br /> �il pp'f "tAMONWEALTH OF USE' s <br /> SEAL <br /> My CommissionE*m <br />