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I - BUSINESS CERTIFICATE#09- db p I <br /> THE COMMONWEALTH OF MASSACHUSETTS ff <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))tthat a business under the title of , <br /> 1• IQC��EQ 9�k\'4� ITCXt,{fit DBA ` is conducted at <br /> CU <br /> Business Location: LAC Na NACLA `P-M� S \�x t •`\W CL µ <br /> Business Mailing <br /> gAAddress: L- OC:- (G..\V S <br /> Business Type:\ �2rf��C� N e� Business Telephone: �7 <br /> .. S0 S - � f -7- -5 4 Q' R <br /> by the following named persons: - y <br /> a <br /> FUr ,NAME RESIDENCE <br /> tom, n2A <br /> yl Home Phone: - <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 /> taaxes as required un law. <br /> *Signature o u orized agent "Signature of authorized agent <br /> "Social SecurityNumber <br /> (Voluntary) <br /> ( rY) <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 /> t <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 /> w The Commonwealth of Massachusetts <br /> BARNSTABLE ss r .;*' t DATE <br /> e Q ` - <br /> Personally appeared before me the above-named \N t\-3R-'` and made oath that the foregoing statement is <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 s nducted and shall lapse and be void unless so renewed. <br /> V Signed96�c� <br /> \/ <br /> Notary Public <br /> SEAL <br /> a " Pubic 90I <br /> Commonwealth of Massachusetts <br /> 3 My Commission Expires <br /> Au ust 28,2009 <br /> r <br />