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BUSINESS CERTIFICATE# 10- O V r <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE /Yo <br /> Expiration Date: : <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigne hereby declare(s) that a business under the title of <br /> DB,& G_ --� �r%a�l��1s conducted at <br /> Business Location: <br /> Business Mailing Address: lK/, ®G• Ctr / <br /> BusinessType: lG'✓ � Business Telephone: 110127f <br /> Home Phone: <br /> by the following named persons: <br /> / FULL NAME // RESIDENCE <br /> %7Gt�G ��G� <br /> 1 certify under the penalties of perjury that t, to the best of my knowledge and belief, have filed all state tax returns and paid all stale <br /> Alftxes as required under law. <br /> 4;�zw/�-�� <br /> 'Signature of authonzed agent *Signature of authorized agent <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: 5(-v <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 Cootatonrvealtk of Massachusetts <br /> BARNSTABLE ss DATE / <br /> Personally appeared before me the above-named S �`� (.l�1 (� 114-fM 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 /> •SignedIj <br /> J EPH L. ,J <br /> SEAL Notary Public <br /> COMMONWEWN OF <br /> ��IreS: <br /> . aaooaa.�ota. <br />