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BUSINESS CERTIFICATE 4 09 <br /> THE COMMONWEAL TH OF MASSACHUSETTS <br /> TOWN OF MASHPEE 11 <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 /> unde ped hereby ecla €(s`fthat a b iness under the title of 1 <br /> - DBA __ - I is conducted at <br /> Business Location: <br /> Business Mailing Address: <br /> Business Type: , �usiness Telephone: <br /> by the following named per ons: <br /> C FFUL��E 'rdL/v\ RESID CE <br /> Le k <br /> �6 �J <br /> Home Phoney 5�() <br /> I certify_ he f perjury that it to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes require oder law. <br /> afore ofauthorized agent email address <br /> �➢IL 32 z �'�� <br /> "Social Security Number <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME:)— ( TELEPHONENUMBERr.)W <br /> Alarm Company: <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 /> Tire Connaoatvea(th of Massachusetts <br /> BARNSTABLE ss T DATE 3 <br /> Personally appeared before me the above-named 'DG kVTj�cy yo o,1-4.4i 1 and made oath that the foregoing statement is <br /> true. <br /> A cert e issu - ordanee with this section shall be in force and effect for fou years from the date of issue and shall be renewed <br /> each four ye Berea so;long as uch business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • - SEAL `Notary PuW Ew, <br /> Conusi13=m <br /> October25,2irea <br />