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BUSINESS CERTIFICATE #09- 5 <br /> TAE COMMONWEALTH OF MASSACFIUSETTS <br /> TOWN OF MASHPEE <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 /> DBA -r! - is conducted at <br /> 6 t + <br /> Business Location: /() o E Chp t2 Od <br /> Business Mailing Address:/ J-p S12:ph 2Son /1w, Ti29y f// qJ0,Y3 <br /> � t <br /> Business Type: Business Telephone: S—D • 539 • O(e 9-7 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone: <br /> f 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 /> ,JMs as required under law. <br /> *Signature of authorized agent *Signature of authorized agent <br /> 3V- 090V5771 -7 <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency - <br /> NAME: M4.Pri' eCD2t<e-h S TELEPHONE NUMBER: 5-D <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 ori9elinqueney 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 5-7.09 <br /> Personally appeared before me the above-named JAN D& 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 Tor four years from the date of issue and shall be renewed <br /> each four years thereafter so long as such <br /> D�s�u'cgh/bussin�essss shall be conducted and shall lapse and be void unless so renewed. <br /> Signed1P�- }l-I�- 711) y �lG <br /> BARBARA M Notary Public <br /> SEAL - kAC <br /> ARY PUBLIC NIACOMB CO.,M <br /> OMMISSION EWRE&DEC.29.2M r <br /> TINGIN THE Commission Expires: <br />