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BUSINESS CERTIFICATE N 092A <br /> T//l, COM19ONFNTALT11 OFAIA VACJIUSET7S <br /> TO IVn'OF MASWIT E, r�0 <br /> DATE &Qryl <br /> Expuauon Lite: December 31, 2013, <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of rhe General Laws, as amended, the <br /> undersigned hereby declare(s) that a business under the title of <br /> Gory ��s�afiah DBA /� ' / FLUE is conducted at <br /> sa Uncle �f�hYys 2oA�, I?2«s/ip�, /yrs( OoZ6s/y <br /> Business Location: / <br /> 1�0. [>Ojt s7a /naJ'ry GG IW4 o1. 6y9 <br /> Business Mailing Address: / /� <br /> Business Type: Business Telephone: -5 3o';77— 76 6 8 - <br /> by the following trained persons: <br /> FULL NAME RESIDENCE <br /> Mary �ynay`iand (JnCI <br /> 0-2 6,€'9 <br /> Home Phone: 6 /7- 9 `/7 - 9,3 7-5- <br /> 1 <br /> SI certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> as required under law. <br /> m c <br /> Q.ss <br /> orgnat ei of au ionized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency - - - - - <br /> NAME: G19A y --YA/47-1,4 v TELEPHONE NUMBER: Sob— y77— 76 6 B <br /> Alarm Company: 11114 <br /> *This license will not be issued unless this certification is signed by applicant <br /> **four 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 susoensi on or revocation. ']'his request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts BAI2NSTABLE ss t llA1'E So/� <br /> Personally appeared before me the above-named V SC�[�.T i C)_`fl 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 Porn-years from the date of issue and shall be renewed <br /> each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed <br /> Signed CVICKI AN OOVONI <br /> - - jNotaPublic <br /> COMMONWEALTHALTH O OF MA$$ACHUSEM <br /> otar' <br /> t9. 17 <br /> SEAL <br /> Commission Expires: <br />