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— - (\ - <br /> BUSINE,SS CERTIFICATE#09- tai <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE �� ( A <br /> Expiration Date: December 31, 2013 <br /> In confornuty 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 <br /> a, a S S ,i//h�� epd G C(.SS p DBA / is conducted at <br /> Business Location: nG ( G�(QP�GT[D.JGt-t C./ e--9� <br /> Business Mailing Address: p�1 Gt:G�ak'e- lel- <br /> Business Type: �JrLt1l7P_Gi S Business Telephone: e17 ;7- 71 cP7 <br /> by the following named persons: <br /> F NAME SIDENCE <br /> //�� <br /> `>UJ'an t oU. (a 4.4 <br /> --bo rald 1p yaougi las, Jr <br /> Home Phone: J//p Z/'77- W <br /> under the penal perjury that I, to the best of my ]mowledge and belief, have filed all state tax returns and paid all state <br /> taxes a requ 'ed nder aw. <br /> .ature 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 /> Alar 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 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 Commamvealth ofMassachuselts <br /> BARNSTABLE ss DATE <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 yeais thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • Notary Public <br /> SEAL <br /> Commission Expires: <br />