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BUSINESS CERTIFICATE # 10-fit { <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2013 <br /> In conforimity 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 /> DBA is conducted at <br /> j Business Location: , 9 �/� n A j�o n eqZ � � ! ; <br /> Business Mailing Address: /JX/C��O <br /> �' <br /> Business Type: nnnpi..v... 'S2 1 n Business Telephone: ff- Z �,�2 <br /> Home Phone:SA 7— �_7 - <br /> by the following named persons: <br /> „ PULLNAME RESIDENCE n <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 /> AMP as required under law. <br /> liA4C�Ia �GIMD <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:?��/ t/ut1.eA TELEPHONENUMBER:SQ . �_Z=39�'T <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 /> F' The Commonwealth of Massachusetts <br /> BARN'STABLE ss t tp DATE <br /> Personally appeared before me the above-named S A N e� ��I'��1` �-�' 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 such business shall be conducted and shall lapse and be void unless so renewed. <br /> {per / 2 <br /> ed ' IL , <br /> l JOSER NLA JR <br /> SEAL terry;M:A <br /> 004Y0HYNEAITH O <br /> Co <br /> I <br />