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BUSINESS CERTIFICATE#09 <br /> THE COMMONWEALTH OF MASSA CHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE'-'�) 92 C'Qyv��2C 'i <br /> Expiration Date: December 31, 2013 <br /> In conformity with the provisions of Chapter one hundred and ten, Section five.of the General Laws, as amended, the <br /> undersigned hereby ddeecllare(s)that a business under the title of <br /> DBA � is conducted at <br /> Business Location: ((�� soy+F l._ Vi <br /> Business Mailing Address: JVt7Y�Ns I Jr�Je- <br /> _ss �yy:�_ II I p 77 1 F�3G — 3u z <br /> 13usinessType 'A'e` i-` Business Telephone: '� - +*.�.u�..^.: + c+c <br /> by the following named persons: <br /> FULLME ENCE <br /> t� <iI 3� RESIDtib' ikwe e . <br /> Home Phone: ' q7?? q6 f, _ <br /> I certify 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 /> s quired undex Ia. -. <br /> Attu/ur' horiYizzzeeedl!'agent *Signature of authorized agent <br /> 02Z- 0Z9L) <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number - - - <br /> In case of emergency -. - -- - - . <br /> NAME:_ j-1 .;TO 1 P 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\ laCD%- <br /> Personally appeared before me the above-named�L c_. R:eu 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 business shall be conducted and shall lapse and be void unless so renewed. <br /> signed 1.t � �\7 �> 7Gv /— NN 1 <br /> • 1 <br /> Notary Public <br /> SEAL ��Comnussion Exrikes <br /> 11,1019 <br /> Commission Expires: <br />