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4 <br /> 4 <br /> i <br /> BUSINESS CERTIFICATE#09- ©cQS <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 /> undersigned hereby declare(s)that a business <br /> under the title of /Q / C <br /> " r SO/fir%Ohf /JDBA //r/ ���� `y� �r / S is conducted at <br /> -Business Location: !// SP✓�le.CC� / "��SGL 6,C e- D 2 <br /> Business Mailing Address: - - Q L� <br /> Business Type: Me.�t�r ' �� Business Telephone: SO� U — / ap <br /> by the following named persons: <br /> FULL N� '/ J3 Se J1 eC�-RESIDENCE <br /> Home Phone: 7 7 / <br /> I under the penalties of perjury th I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> axe required under law. <br /> rfauthorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: C/r�Ll � ( ���SS TELEPHONE NUMBER: r� �i O <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 Deparhnent 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 q� <br /> BARNSTABLE ss lr DATE (' [ 0 <br /> Personally appeared before me the above-named J /! Fq 1% P a� L%4,1 made oath that the foregoing statement is <br /> 'true. <br /> ificate issued in accordance wit tis section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each m y s t ereafter so long as such si ss shall be conducted and shall lapse and be void unless so re wed. <br /> Signed <br /> HELD,JR <br /> SEAL NotaryPublic <br /> COMMO <br /> ComiAtls�yr TTS <br /> 25,1012 <br />