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BUSINESS CERTIFICATE# 10-_a_4/ <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br />' DATE ���, � -2o 10 <br /> i t <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/deeclare(s) that a business under the title of <br /> Iy P_1w rr� (_ eA-6—Lua L(r II / DBA �V L is conducted at <br /> Business Location: 14 � �V t a l5 l6e ✓l-e <br /> Business Mailing Address: tol( Ln,4f. L 4 r-L`0 <br /> Business Type: a�ZuI- �Z�-�� - <br /> ^ Business Telephone: SbK� <br /> Home Phone:o5ZY- (b73 - �C. 1 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> 4L_Oata1w �kA{rUJbL_I_ �q Lnye LL 5 <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 /> &s as required under law. <br /> *Signature of authorized agent Signature of authorized agent <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 BARNSTABLE ss DATE °Z t ZCI/D <br /> Personally appeared before me the above-named/^t'(1 �)tN'= lJ'rt'/ w-ZI 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 four years thereafter so long as st business shall be conducted and shall lapse and be void unless 7ewc <br /> d. <br /> j igned G � <br /> H L.MAaUCd1EL1.1�AR <br /> yolA blic <br /> SEAL <br /> fVr1d OMMONWEALTN OF M�SMg1y8E <br /> My Camrtvssiott E.xpitas <br />