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• ' BUSINESS CERTIFICATE#09-, <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWNOFMASHPEE <br /> • DATE <br /> Expiration Date: December 31, 2013 <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 /> Kimbey-1 Martin DBA Bagel Naven is conducted at <br /> Business Location: U%l FCAIMQU+h Rd Jnfl N3 Mma pee , MA OdU49 <br /> Business Mailing Address: r p ' I <br /> Business Type: Nq I CoRe , Business Telephone: <br /> by the following named persons: <br /> FULL NAME RE IDENCE <br /> Ki mberlu Ann Marby) A Tarpni IR . � Fal Mou+l MU o a53G <br /> HomePhone: <br /> I certify 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 /> taxes as required under law. <br /> Mw9nature of a�uth rized agent *Signature of authorized agent <br /> 2,,'1- maa44 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency , <br /> NAME: MlrhaO W(r 60o'h TELEPHONE NUMBER: I I I'ZZ6{ '�0732 <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 _ <br /> BARNSTABLE ss DATE t <br /> Personally appeared before me the above-named\4_ Pa� � 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 years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed M'Cnn.L. <br /> • VICKI ANN N <br /> ,.hh <br /> Cbi�I]JIC6F MA9SACHUSETB <br /> SEAL My Cotnrnission Expires. <br /> 19.P13 <br /> ommtssion Expires: <br />