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BUSINESS CERTIFICATE#08 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2-B-H <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 of <br /> /iICOIt /�IC/�lV{lQ✓) / DBA J7t�T L (�1 is conducted at <br /> Business Location: 2 <br /> Business Mailing Address: to box /.3S- mos M,* x26119 <br /> II t <br /> Business Type: Business Telephone: 96 V-4- 2_1,0 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> /i1Go6eMtef(Aa,✓1 ✓,092 ?dbirlart rLd ?tZUlS a2L3 <br /> Home Phone: 6Z,5 8 <br /> 9(0 <br /> I certify under the <br /> 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��qL, i law. <br /> *Signature of authorized agent - - *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 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 yezKs thereafter so to g as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • Notary Public , <br /> SEAL <br /> Commission Expires: <br />