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BUSINESS CERTIFICATE#08_7/ <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE )Q <br /> Expiration Date: December 31, 2012 <br /> i <br /> in conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> u <br /> ndersigned hereby declare(s)that a business under the title of <br /> �1Dfal (YY11 r�\-��//��',UQ DBApny/1�/',, r- '1/n�//1� /t / is conducted at <br /> Business Location: I 1 l,Q Q." V - t n` O cl V <br /> Business Mailing Address: G / <br /> Business Type: ( Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCEnGlewnc�Q <br /> ;g- CLI-411401 <br /> A- 6 a ieS S <br /> Home Phone: 50% cost 'set 35 <br /> 7 <br /> � <br /> rtify 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 /> s as required u er law.\ <br /> *Signature o auth ri ed nt *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 <br /> BARNSTABLE ss D,t�¢ DATE d 3 6 <br /> Personally appeared before me the above-named letgUrS L N r Ko and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance Xith this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years there a so long as such sin s shall be conducted and shall lapse and be void unless so renewed. <br /> �ed <br /> SEAL COYNCNWEMTH OF MASSICH <br /> Comrry��pT;s: <br />