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BUSINESS CERTIFICATE #09 3 <br /> THF COMMONWEAL 7R OF MASSACHUSF_TTS <br /> TOWN OF MASHPEE <br /> DATE 1 <br /> Expiration Date: DeceinbeY 31, 2013 <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the- <br /> undeU <br /> reby declare(s)that a business under the title of - �- - <br /> Ia C 9"'o�� ,f �D�BA OF'A /M <br /> /,tom 4 is conducted at <br /> Business Location: /�OJaU �iie,A) J( NICt�,�4ge e /�f�/ ,,//C�cu y/9 q _ <br /> Business Mailing Address: Andy0d,40 ))�M61S T,1 MT t_2& <br /> Business Type: Business Telephone: <br /> by the following named persons: -. <br /> FUL AME RESIDENCE <br /> �A/' � ✓VIS LQy�a� 1/1evJ �Y <br /> ap 0"qw 9 <br /> Home Phone: SQ1jc— <br /> I Icertify under the et alties of perjury that I, to the best of my knowledge and belief,have filed all state tax returns and paid all state - <br /> s as regdre r law. <br /> *S t/mrized aggeentt--�j *Signature of authorized agent <br /> **Social Security Number(Voluntary) - - - . . . <br /> or Federal Identification Number - <br /> In case of emergency -- <br /> NAME: ���h�/S ��✓/� S TELEPHONE NUMBER: 7rD(r QL Ya�o� <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 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 /> BAI2NSTABLE ss / DATE <br /> Personally appeared before me the above-named I;i S ' AII/S and madeoaththat 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 thereaf r ong as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed0 <br /> — (� <br /> V``hl '. <br /> Deborah F. Dami Notary Ppbl <br /> SEALa <br /> �� NOTARY PUBLIC <br /> Commonwealth of Massachusetts Commission Expires: <br /> My Commission Expires July 24,2009 <br />