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BUSINESS CERTIFICATE#09-0,5'8' <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE / n <br /> • DATE (O cT G9 <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 1 <br /> DBA ',�hU22 `A\ is conducted at <br /> Business Location: (Kk <br /> Business Mailing Address: <br /> Business Type:�f 0 -,A'61y\Q U VhJVv-hQ_,S Business Telephone: 56� <br /> by the following named persons: <br /> FUL NAME ` RESIDENCE <br /> lrc. �ee l sc�� - O�rew©ob <br /> Home Phone: 0 <br /> I certify under the p alt es o peryfiry that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as qu' d d' w. J <br /> lWnature of aut rized ge t *Signature of authorized agent <br /> 5l i-T-L--`�o' <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: Xf'r I Il` DD TELEPHONE NUMBER: _5�0� 1091 _0 <br /> 91 _0 "(I <br /> Alarm Company: <br /> *This license will not be issued unless this certification is signed by applicant <br /> "Your social security number will be famished 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 & F <br /> Personally appeared before the above-named and made oath that the faregoint statement is <br /> true. <br /> A certificate i5ped or ance 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 therea ers s ch business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • /J0SEPWVVAUUXHELD,JR <br /> SEAL IJ Nolary Public <br /> COMMONWEALTH OF MASSACHUSETTS <br /> @ASP�R7d$s: <br /> October 25,201 <br />