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O S� .. - <br /> BUSINESS CERTIFICATE#08 7 <br /> • THE COMMON6IWEAL7W OF MASSACIIUSETTS <br /> 7'O6VN OF MASHPEE �� (� <br /> DATE 1 � 1 9 t o20Qp <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 /> undersigned hereby declare(s)that a business under the title of <br /> C " lah)olh DBA 'F)r,5-E dj Cnn+racflnc CO , is conducted at <br /> Business Location: Ona b t nch dl l', <br /> a 3Qd� Oa�k, 4 9 <br /> �1��Business Mailing Address: Qn (h s � n � <br /> L49 <br /> BusinessType: l A+rad <br /> ( r1 G Business Telephone: 509 �5aR 0(906, <br /> by the following named persons: <br /> F L NAME RESIDENCE <br /> rdtl ahoy C)ry (. dy Mashpaa `M 4 (7c) 149 <br /> Home Phone: VJ r) - 11 <br /> ertify under Che 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 required under]aw. <br /> I�Y�nrrm �aba�m <br /> "Signature of authorized agent `� "Signature of authorized agent <br /> 06 - R� / <br /> "*Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: G f I ���7 V ( Vl 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 / b <br /> BARNSTABLE ss 1' 2 �'p�� DATE `-/ ,� <br /> Personally appeared before me the above-named k14tRCmst/ ( \ 1 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 j <br /> each four years there1 ftei so long ash business shall be conducted and shall lapse and be void unless so renewed. - <br /> led rylIAO �OJ <br /> J S CY C LLI,JR <br /> SEALNotary Public <br /> F MASSACHUSETTS <br /> COIAIP�I10ia <br /> October 25,2013 <br />