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BUSINESS CERTI F1CATE#09-"p <br /> I'IIE COMMONI11EAL7II OF j1ASSACHUSFTTS <br /> TOWN OF MASIIPEE <br /> • <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 /> Ge�_IDBA �7 A <br /> Z) is conducted at <br /> Business Location:_ �\f Nehoat& ,UQR{ <br /> Business Mailing <br /> Address: �+"q RA <br /> Business Type: LXX} �� -�o�,pl1G� �idO� Business'I'elephone: Off 3' , �'3�.1�i <br /> mar(ar eKCCj'eS <br /> by the following named persons: <br /> FULL NY. E RESIDENCE <br /> Irl C �M�u1C� <br /> 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 /> taxes as required under law. <br /> � :nr/o 9'f9a2�.5/1C �Bi7? <br /> rare of authorized agent email address <br /> "Social Security Number <br /> or Federal Identification Number <br /> In case of emergency �^ ,/ <br /> NAME:,�cJ(,'� r�24MOWAI TELEPHONE NUMBER:uidk JJ 7 ��7 <br /> 7' <br /> Alai ��^n Company: /c la - <br /> **four social security number will be funished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax <br /> payment obligations. Licensees who fail to coned 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 Coninrmnnerrith of Mrassetclursetts <br /> BARNSTABLE ss DATE <br /> Personally appeared bcfore me the above-named and made oath that the foregoing statement is <br /> Iruc. <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 fon-years thci eafter"so long as suchbusiness sial llYe-con ucted end shall-lapse and-Ge void unless so renewed.-- <br /> Signed <br /> Nbtary Public — <br /> SEAL <br /> Commission Expires: <br />