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BUSINESS CERTIFICATE#08 `V 3 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TO PVN OF MASHPEE <br /> DATE /M/61) <br /> Expiration Date: December 3�1y 20122 <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 f <br /> �Lf 7t/S/ �i ✓C JU/U fi`dUf %q/t t4%UJUAKDBA `1 J6 ✓i Gam(/ Zr IL- is conducted at <br /> Business Location: /�'O J ti y 4.1 YV e /v!G-, /j am 6 t! <br /> Business Mailing Address: <br /> _/_.-- <br /> Business Type:,01,a l,(¢/.L/ip[/9 J////GFf Business Telephone: <br /> by the following named persons: ` <br /> FULL NAME RESIDENCE <br /> r <br /> //a/- <br /> Home Phone: - /�a•f�P�e ��_ � � y <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 /> es as�regbired under law. <br /> /�!7t Cis <br /> * i� ature of authorized gent - *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 pp <br /> BAIL�ISTABLE ss . . t DATE <br /> Personally appeared before me the above-named SUlknJ wy Z I AC_ 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 thereaftte/eer/rS long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> SEAL JOSEPH L.M HELU,JR <br /> Nota Bc <br /> Wi <br /> My Comm ton roe <br /> t <br /> . CMW 25.2013 <br />