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_ - ----- - - -- <br />- ---- , - BUSINESS CERTIFICATE#08 '3� <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE [' <br /> DATE <br /> Expiration Date: December 31, 2012 <br /> hr 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 /> �t�..��yI'J E/6J-r/(i DBA �!/� �/�'� .a�e is conducted at <br /> Business Location: �6 �6�� 11171& /..V/le G24, <br /> Business Mailing Address: '9M'e/ <br /> Business Type: Ale'oz Z6 A9l�' 19?y KPlle' Business Telephone: <br /> by the following named persons: - <br /> FULL N E RESIDENCE <br /> Home Phone: J / /' <br /> certify and the penalties of perjury that I, to the best of my knowledge and belief, have file all state tax returns and paid all state <br /> es a qt -ed under law. <br /> r a 'e of authorized a in *Signature of authorized agent <br /> �6'?3 �D C;2 j-0 <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 nimrber will be furnished to the Massachusetts Deparhnent 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 Gencral Law,Chapter 62C,Section 49A. <br /> The Contmonrvealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named ���/Y� �`l ��w 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 fom years therea s long as such busine hall c ducted and shall lapse and be void unless so renewed. <br /> �ned <br /> 1 Deborah F: Darni Notary Pn lie <br /> I' <br /> SEAL} c� NOTARY PUBLIC <br /> - f I, . <br /> Commonwealth of Massachusetts <br /> t, My Commission Expires JUIy 24,2 Connnission Expires: <br />