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BUSINESS CERTIFICATE#09-3c <br /> THE COMMONITIEALTF/OF MASSACHUSETTS Y 4 <br /> TOWN OF MASHPEE <br /> • DATE 1�� G <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 dechue(s)jjthat a business under the title of M ( _ <br /> 2n�C'IT E_ /q �LlYP/S DB[A� [19 (� ain/Q �A_ is conducted at <br /> Business Location: <br /> Business Mailing Address: 7 l II``!�Q y <br /> Business Type: 4.rra 4 ( Business Telephone: ��n $� �/ T t —k2-1/a <br /> by the following named persons: - <br /> , <br /> FULL NAME RESIDENCE � <br /> I?n �orr E• Iaka'ko ILFS ✓`(a� ?Z-Wf / �/ iaee 1-t4ioa6y9 <br /> Home Phone: t� ,f <br /> z—� <br /> I certify under the penal ' s 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 requ' un w. <br /> nature o thorized agent *Signature of authorized agent <br /> **Social Seem try 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 Conueonivealth of Massachusetts BARNSTABLE ss p L DATE �L �LOOg <br /> Personally appeared before me the above-named Rob ,"I l�ni 1l1`) 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 foo years from the date of issue and shall be renewed <br /> each four years there er so ng as such business shall be conducted and shall lapse and be void unless so renewed. _ <br /> Signed ..�� �i <br /> Notary Public <br /> SEAL Deba �h DOW NOTMY PMC <br /> COMMOW&UN of i Commission Expires: <br /> My Coma"an EOM Jldy 29.2M6 <br />