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BUSINESS CERTIFICATE# 09- THE COMMONWEALTH OF MASSACHUSET'T'S TOWN OF MASHPEE DATE_ Expiration Date: December 31, 2013 In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the undersigned hereby declare(s) that a business under the title of - A.4'1Pt1J �,�/�. DBA_K,,\/ is conducted at Business Location: Z2— Business ZBusiness Mailing Address: Business 1')'Pe:CeyyTij�. - L 61f Business Telephone: by the following named persons: S'/4-d/t I duilo'f- FULL NAME ,t RESIDE CE y� �'oofi/ Y1t Home Phone: tf 7 L-3 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 taxes as required and v. ature of authorized agent *Signature of authorized agent **Social Security Number(Voluntary) or Federal Identification Number - A II In case of emergency NAME: �Q Lc`~ ) /�� /'Tt` M TELEPHONE NUMBER: Alarm Company: - *This license will not be issued unless this certification is signed by applicant "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subieet to license susoeasion or r`vccat3or This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. The Commonwealth ofMrassachusetts BARNSTABLE ss DATE � �2- Pei sonal ly Personally appeared before me the above-named and made oath that the foregoing statement is true. 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 each four years thereafter so long� Lich business shall be conducted and shall lapse and be void unless so renewed. - Signed rotary Public SEAL - - Commission Expires;