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y BUSINESS CERTIFICATE# 10- 03S <br /> THE COMMOMVEALTIIOFMASSACHUSETTS <br /> TO 6VtV OF AlASHPEE <br /> DATE <br /> Expiration Date: December 31, 2014 <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 <br /> I�Ia>1aGtl E -ikiOlt 5 DBA fi�1A Colt r-c,Ct-OY' S is conducted at <br /> Business Location: "100 C.t-eattn dt1?0 Moe)-� /—tc.(,3 (\ . A45 0Zi.,-1 9 <br /> Business lWailing Address: SG O\A . <br /> Business Type: 'b,)t J 1 r Business Telephone: -j 36- Z 3 —7 <br /> Home Phone: S0C3 `I1q (d�3 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> �� n�/ill C �1zQ S Noo or�Pu�.td, �'d A.d:6 <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 /> xes ash 'red under law. <br /> *504enature of authorized agent *Signature of authorized agent <br /> cb3 !08 a�3 y <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> ' ,A] - L In case of emergency <br /> NAME:}/u f4 &5 TELEPHONE NU1MBER77t/`f13& 9,1? -3{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 /> Br\l2A'STAI3LE ss DATE /71 <br /> Personally appeared before me the above-named '��c-�— �j VL� ��"' 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 fart years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signe�d�' / <br /> Z. <br /> SEAL Jds <br /> EP— J <br /> UPI <br /> Notary Public <br /> c <br /> WIF <br /> WOW 25.2013 <br />