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--- - - - u n V19,_ r BUSINESS CERTIFICATE#08 - OL <br /> 35 wf ns� _ <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE g <br /> • Gly lr �� DATE - d, <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 /> undersieneedhereby declare(s) that a business under the title of Q <br /> 60JR _Ja�KQtias /j� G DBA N� 6-jdp/S is conducted at <br /> Business Location: I (P� U�o f I'U ` , 1/1,a S / <br /> I <br /> Business Mailing Address: PD Bo }- acio 2 I � q 5h e:�v {M Qa 6 99 <br /> Business Type: Ca 4 5v(VJf-I Business Telephone: 5 0.b— L`'7 / — , Ao6 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone: <br /> I certify 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 /> axes as required under law. <br /> *Signam thori gent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> yy /( In case of emergency - <br /> NAME: hn fl k V*�./c.N///w'''u.tn TELEPHONE NUMBER: <br /> Alarm Company: <br /> *This license will not be issued unless this certification is signed by applicant - <br /> **four 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 <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 years from the date of issue and shall be renewed <br /> each four year ereafter o long as such business shall be conducted and shall lapse and be void unless renewed. <br /> Signed _ <br /> JL Notary Public <br /> SEAL §� EPH L.MAaUCMEW, <br /> o,y COMM0NWEALT H9aVR"aAMUXdS SW of$3: <br /> 1�Wh�y My Cornffm nEVres <br /> 0=bw 25.2013 <br />