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BUSINESS CERTIFICATE#09- <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE z6 r//QY <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 <br /> )that a business under the title of <br /> y. ��r� i rp DBA / is conducted at <br /> Business Location::�l� - // <br /> Business Mailing Address: �?'6Z ///,,p f- <br /> Business Type: c/�(� �(,( � Business Telephone: &—d F-',,s i 9 <br /> by the following named persons: <br /> �jUL AME /� SI ENCE <br /> Home Phone: _ {y� t�3 /' a `It�� 4d< <br /> / �C� / <br /> I certify under the penalties of perjury that I, to the best of my knowledge a d belie , have filed all state tax returns and paid all state <br /> taxes as required under law. <br /> re of authorize gent *Signature of authorized agent <br /> 19 Q -3 02 - -9 iL <br /> **Social Security Number(Voluntary) - <br /> or Federal Identification Number <br /> In case of emergency q <br /> NAME: _S nil ' Lrz_7TS TELEPHONE NUMBER: , ydcS <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 subject to license suspension or revocation. This request <br /> is de under the authority of Massachusetts GeneridLaw, <br /> --CF G2C;Section-49A; <br /> ma <br /> The Con'linonwealth of Massachusetts BARA�STABLE ss DATE 111.2 �741(tp <br /> Personally appeared before me the above-named U A a1 /t 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 thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed ^ V <br /> • JOSEf PHIL." CHEW,JR <br /> SEAL a Npf�yr pliDli;. <br /> COMMONWMTH 0►MASSACHUSMS <br /> Con1aN�R�p2013Sr� <br /> 25,2013 <br />