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3 - <br /> 1F —-- <br /> "` BUSINESS CERTIFICATE#086 `a <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: DeceiiiheP 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 declaie(s) that a business under the title of <br /> DBA My,e� F+>l. �L �eak� is conducted at <br /> Business Location: e / ! u / /� GJ.6Y5 <br /> Business Mailing Address: <br /> Business Type: Q���� Business Telephone: (rC'0 -6S6y <br /> by the following named persons: - <br /> FULL NAMERESIDENCE Oa C7f <br /> T M Ells Ss Q <br /> Mt�r /L'/cr. oaw <br /> Home Phone: <br /> 0ertify 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 required under 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: c( -4-L 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 icon-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 tI-Id <br /> 'tom F—Ws <br /> Personally appeared before me the above-named ^Cti• .mc C4-r _and made oath that the foregoing statement is <br /> hue. <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 fouAyea;s ea,er so long as such business shall be conducted and shall lapse and be void unless so renewed. - <br /> tied <br /> Margaret C. Santos Nokary Public <br /> SEALNOTARY PUBLIC <br /> Commonwealth,otMassachusetts R'ay--aol b <br /> ovy Commission Expires Sept.24,2010 Commission Expires: <br />