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BUSINESS CERTIFICATE#09- CO , <br /> THF COMMONWEALTH OFMASSA CF/USETTS <br /> TOWN OF MASHPEE <br /> • DATE ilim <br /> Expiration Date: December 31, 2013 <br /> Lm 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 /> pm\ ONIP't an,, _DBA is conducted at <br /> Business Location: q6 N,C0\2-ate WA tANN* .1 MA M641 <br /> Business Mailing Address: S21L. VAr'Ll '+a Q'0 r h t MQ W'Suo <br /> Business Type:1ylwi Business Telephone: SO$-y9s- 1411 - <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> \CrF rte \�jwea <br /> ata �i24CSea way t �1yo�� , A U a 601 <br /> Home Phone: <br /> I certif 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 s equired under law. <br /> nature of authorized agent *Signature of authorized agent <br /> LA-L5('tp-ssn <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> L <br /> �1 nn In case of emergency <br /> RLL e71O /�p D p <br /> NAME: e ZOeWAJ G 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 subieet 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 <br /> Personally appeared before time the above-named RI etme o D. H OW E 5 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 hereafter so on as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> otary P r <br /> SEAL{ Ak4GrCORk�F <br /> h <br /> nnussron Rdb <br /> earntw rxm <br /> OF wttwcw <br /> W Cannlplon Stow <br /> a.ao+a <br />