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J <br /> BUSINESS CERTIFICATE#09- 3tP <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE <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 1 <br /> DBA l 0 L C Q h is conducted at <br /> Business Location: <br /> Business Mailing Address: �/ t / <br /> Business Type: 1 h`�'e-t- H e'f" C�1 es 'Business Telephone: � G b 'Ll 7 <br /> by the following named persons: <br /> FULLNAME REDENfCE <br /> I Paul Lo t- � r- S iq— I, ie <br /> Home Phone: S6 R� 7 <br /> I certify wider the penalties of perjury that I,4o the best of my knowledge an"o ' returns and paid all state <br /> taxes as required under law. <br /> a e of authorized age rg <br /> �� 6 - �1 � 1 L��/ � �/ <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 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 / OJ..rG�y <br /> BARNSTABLE ss p DATE 121 0) <br /> Personally appeared before me the above-named 11I55GIG T 7-41 7lQ \J nd made oath that the foregoing statement is <br /> true. <br /> A certificateissued in accordan ith.this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four year er r so long siness shall be conducted and shall lapse and be void unless so renewed. - <br /> l)$�- <br /> Signed <br /> • <br /> 0MY <br /> otary PublicSEAL Deborah F. Dami <br /> ComonOwealh ofMassaeusettsLIC Commission Expires: <br /> Commission Expires July 24,2009 <br />