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- 7`f <br /> BUSINESS CERTIFICATE #09 <br /> THE COAIMONVI'F_ALTH OFAIASSACHUSLTTS <br /> TOIVN OF MASIII'FL' <br /> • DATE 7 J•C) UU <br /> Expiration Date: Decentbei- 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 hereb�y+decla e(s) that a business under the title of <br /> ' ,, n is conducted at <br /> Business Location: - !S ta Ulaeuwateh wa __ �Iash7 '-e' I"V'rOxi0g9 , <br /> Business Mailing Address: I5 - C31QekWuteh W aq, I� gs_hpe& MA 03. 099 <br /> Business Type: JOVII[_ C/' I'I Cf17 ft(, 0r Business Telephone: .�O�' 7✓�T" awl y�7 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> ar C lues-} IS [3lcrckwaNO, <br /> 02&q9 <br /> Home Phone: 50 a- 573 9 - 369 7 <br /> I certify under die 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 /> , iur�d@ ►'u Ft��cruft,eo rvl. <br /> *Wtu of authorized agent email a dress <br /> EIN ao - 874739qr <br /> **Social Security Number <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: S0.1,1r W PSt TELEPHONE NUMBER: 508" 737' 3 Y7 <br /> lure-d West• <br /> Alarm Company: n <br /> **Your social security mmniber 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 Massachuselts General Law Chapter 62C,Section 49A. <br /> The Commonwealth of Alassaclutsetts <br /> BARNS TABLE ss DATE oka 'DO 05 <br /> Personally appeared before me the above-named Y/ t r'/f'[,/ A , L}�Cy P/S 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 fow years from the date of issue and shall be renewed <br /> --cacli foul-years thei eafier so long as sucltiusine�iall-be conducted and sKall"lapse and-6e void unless so renewed-- ---- ---- - <br /> Signed <br /> 10tary Public 1 <br /> • SEAL OWYCommission <br /> Margaret C. Santos V <br /> NOTARY PUBLIC 9-ay- � to <br /> Commonwealth of Massachusetts Commission Expires. <br /> Expires Sept.24,2010 <br />