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BUSINESS CERTIFICATE#09 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE 1 <br /> DA'L'E <br /> Expiration Date: Deeeinber 31, 2013 <br /> In conformity with the provisions of Chapter one hundred and len, Section five of She General Laws, asamended, the <br /> undersigned <br /> hereby declare(s) that a business under the title of -- <br /> I°I9l7 YYY�t7Pr-��S I- DB�JA,,o is conducted at <br /> Business Location: 1 (A) Y 1 �� IL f/ tom✓' <br /> Business Mailing Address: Vo P:)cX i a u7 - n 2 Q <br /> Business Type: (ZP-CLI �-{rA Q. Business Telephone: l.0 l7-_ l J�" I�� Or <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> � Lnp;R SIgLCa L4rF Id OaL&q� <br /> )AO 2-< 5A-I�6 u F�-IP_n <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 /> es as require under law. <br /> 'Signa re of a thorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) -or Federal Identification Number ......-.. <br /> �� " � <br /> ,, n In case of emergency <br /> NAME: &RjAi � PaQ.r � _ - TELEPHONE NUMBER: 6 ,3 - —1 <br /> Alarm Company: - 213--�- 6o V <br /> � <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❑r tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subieet to license suspension or revoeatimt. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts J <br /> BARNSTABLE ss DATE (3 U <br /> Personally appeared before me the above-named 4�A V(i,-V t fXRO and made oath that the foregoing statement is <br /> true. <br /> A c�f ificatc issued in accordance with this section shall be in force and effect for four years fm rothe date of issue and shall be renewed <br /> each four yea�S thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> JosE <br /> SEAL ryotay Public <br /> MMOHW,���EpppA���LTH OF MpggAOHU <br /> Col������ '' �s: <br />