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~ BUSINESS CERTIFICATE#09- (57 <br /> THE COMMONWEALTH OF MASSACHUSETTS <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 /> undersi ned hereby declare(s)that business under the title of <br /> ��Tf/ AZ-MBA is conducted at <br /> Business Location: <br /> Business Mailing Address: <br /> Business Type: AP.;a/ / Business Telephone: <br /> by the following named persons: / <br /> / 1 CB <br /> . r1 SL✓l <br /> I <br /> Home Phone: 77y- 31Y—— D2 6b <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 /> *Signature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> // In case of emergency <br /> NAME: h0./�� !�C/M TEI-EPHONENUMBER� _�75 <br /> Alarm Company: N D T <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 ficense suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts C <br /> BARNSTABLE ssy� _ DATE (f v <br /> Personally appeared before me the above-named /Jl/G/// �/,-/�>s�nd 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 the ter so long as su Ifblu; <br /> es shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Notary Public <br /> SEAL <br /> �� <br /> &C08 <br /> ", r <br /> { Notary Public <br /> COMMONWEALTH OF MASSACHUSETTS <br /> My QIXIlmisaWn Expires <br /> Oobber 25,2013 <br /> i I <br />