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BUSINESS CERTIFICATE#09- ,f& <br /> L. <br /> -I,FIE COMMONWEALTH OF MASSACIIUSETTS <br /> TO FVN OF MASHPEE <br /> • DATE p <br /> Expiration Date: DeCe172ber 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) thata business under the title of <br /> yl/ g �C.✓�� ���� DBA is conducted at <br /> Business Location: L <br /> 7 ,� �� /t,�r//� <br /> Business Mailing Address: � �. �G X O-c'�.) 5 11 t�tlF6e " J1 LGA <br /> Business Type: I' . / /VV <br /> t Business Telephone: 500 — <br /> by the following named persons: <br /> FULL AME SIDENC <br /> /�PNritirZ r 2._' i �9 !% rod sh pier /Of <br /> Home Phone: LO 7- S 7 t () <br /> 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 <br /> equired under law <br /> tax as r <br /> nature of authorized agent *Signature of authorized agent <br /> 0.3t,- 3c,� _ J10 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number - <br /> - <br /> / In case of emergency (� <br /> NAME:/'"//a "V I-2 !/ 4/�2i 11-f TELEPHONE NUMBER-5 <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 subieet to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Coaunomvealth of Massachusetts <br /> BARNST ABLE ss /�q / DATE <br /> Personally appeared before me the above-named��O[a7 kkrz /YI,4,1 and made oath that the foregoing statement is <br /> u ue. <br /> A certificate issued in accordance with this section shall be in foce and effect Cor four years fi-om the date of issue and shall be renewed <br /> each four years <br /> thereafter so long as s/uc i business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • �- V Deborah F. DamiN44SL� <br /> SEAT. ° NOTARY PUBLIC <br /> — j Commonwealth of Massachusetts <br /> My Commission Expires July 24,200 Commission Expires: <br />