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G <br /> r BUSINESS CERTIFICATE#09-C1 7 oZ <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE °Z D <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 /> R nsr�g-r �A n-z4wa,j DBA 51RoW of is conducted at <br /> Business Location: °I K`t_P\t In oo -TO S2\ y T--- _ )I k�,)j p17--F ' � A <br /> Business Mailing Address: <br /> Business Type: t?Rdtnn-r\nKhL_ PR0V\KLr5 Business Telephone: SOR — tt)q — )C IZ <br /> by the following named persons: <br /> FULL NA 1ME RESIDENCE <br /> nmr�R 1�, Vo5S0NA-<" S-q <br /> Home Phone: <br /> I certify under the penalties of perjury that 1, 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 /> nature of authorized agent *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 famished 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 Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE <br /> ¢� f I ��se�s ti o �✓ <br /> Personally appeared before me the above-named 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 four years from the date of issue and shall be renewed <br /> each four Years thereafter so long as such business r, be conducted and shall lapse and be voibunlemss o ewed. <br /> Signed C <br /> ZZ LI,JR <br /> 1. wu;n..._NO[ary pl�HU6ETT5 <br /> SEAL Expires <br /> • .et 25.2013 <br /> Commission Expires: <br />