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BUSINESS CERTIFICATE#08�h J <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2012 <br /> In confomuty 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 /> DBA ,�^ d is conducted at <br /> Business Location: 4j � P4 N &55� �U eM) r- MA ' a r2 164? <br /> 14 <br /> Business Mailing Address: rY" Mx d-5- yy-Rfv e S , MA 6 ,a601 <br /> .Business Type: Itnl��[)C/ 42 J_ � G' Business Telephone: 7^-►�-I -931 Q Q�.� <br /> by the following named persons: - <br /> FULL ME( 7 RESIDENCF�l �� fR�GA 4 �d ltfl�n' tje45e <br /> 7 Q0 /�m - o4q <br /> Home Phone: <br /> "teo <br /> ies of erjury that I, to the best of my knowledge and belief, have filed all state tax retums and paid all state <br /> w. <br /> 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 /> BARNSTABLE ss <br /> The Commonwealth ofMrtssncluDAT \ W <br /> rse[ts -. y� <br /> �\ h _ <br /> Personally appeared before me the above-named�d`(� 0. �•��Q��' 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 ears thereafter so long as such businessshallbe conducted and shall lapse and be void unless so renewed. <br /> �ned` \ AN OVOM <br /> Notary Public <br /> otar) j mesion Eq*es <br /> SEAL - %2019 <br /> Commission Expires: <br />