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i <br /> BUSINESS CERTIFICATE#09�7� <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE G <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 /> undersigned hereby declare(s)that a business under the title of <br /> r l L /V1 C n y DBA 5? pe flint ( h eafil�4� rD <br /> X eyO% e_Ynducted at <br /> - Business Location: `T.Z /2�/— erBSr pr i,-e— <br /> Business Mailing Address: eo +l O x ( � /- `Lf`1�J B e, <br /> i <br /> Business Type: �eT y -SeryJ'GP f Business Telephone: Sig ' 741t <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> C Z41e07Z 4f For{sr yr, <br /> Home Phone: SOF qS32 <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 /> nature of authonTgent *Signature of authorized agent <br /> 6158 — 66 — D-S6Y <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number - <br /> In case of emergency <br /> NAME: 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 subject 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 f� vA <br /> BARNSTABLE ss F,p , DATE d' �1 <br /> Personally appeared before me the above-namedL. 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 JZ <br /> IEOMIJ( <br /> PW�. JR <br /> SEAL Notary P <br /> ONWEALTH 0 MASc4PNpcl W25, 13 <br />