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BUSINESS CERTIFICATE # 10- <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE -3 <br /> Expiration Date: 3 <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 /> DB�AAs conducted at <br /> ' <br /> BusinessLocation: <br /> Business Mailing Address: 20 F,ox- (_ 7 1 <br /> Business Type: e"' e A"i I cj Business Telephone: �-oF 'j -77 <br /> to 2 ZF— <br /> Home Phone: -<()F17 "1 -'I 0.3� <br /> by the following named persons: <br /> FULL NAME RESIDENCE <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 as re Ltired under v <br /> I <br /> *Signature of authorized agent e *Signature of authorized agent <br /> *40 y -3 z 7 Y6 -3 <br /> curityNumber(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME:1`6U.Wa-S TELEPHONE NUMBER:Sol' 2.2 G 3 S2__L1 <br /> Alarm Company: S.F IQ P_ tJ C_k4 <br /> *This'license will not be issued unless this certification is signed by applicant <br /> 00Your 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 ojMassac/utsetts <br /> BARNSTABLE ss �\'1 DATE 3Al, <br /> /d <br /> Personally appeared before me the above-name 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 SLIC4USiness shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • r�'t!(�'�r'.'� <br /> =,Q7g="13xoircs: <br /> SEAL ' <br />