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- - BUSINESS CERTIFICATE# 09-CD / <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATETS 1511 10�_ . <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 declaie(s) that a business under the title of <br /> /�,'��u,p,� / ► A��r/ !6 DBA /JS�Jti_ h ( is conducted at <br /> Business Location: - /s- <br /> Business Mailing Address: So�t yjiL2 <br /> z�Q _f `� <br /> Business Type: ,� fu1 /yjt ,�N��ll Business Telephone: ) --�__6� r <br /> by the following named persons: <br /> FULL NA E. RESIDENCE <br /> iA)C t1k(,e f� <br /> Home Phone: <br /> I certify under the penalties of pert y that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> - taxes as require. n r 1 w. <br /> gnatuutli ize a n *Signature of authorized agent <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 taxfiling 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 /> -------- ---- - -- - - fi --- <br /> is made under-the auth-or of Massach-—usetts--G- eneral--Law-,-Chapter 62C,Section 49A. <br /> The Cornnionwealth of Massachusetts / v <br /> BARNSTABLE ss ,J <br /> DATE <br /> Personally appeared before me the above-named rz j Cf4*0 l" O IH44"G'f(l and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in aceordan e with this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four yea hereafter so for as such u iness shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Notaiel � <br /> SEAL <br />