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BUSINESS CERTIFICATE# 10-d� <br /> THE COMMON 6VEALT H OF MASSACHUSETTS <br /> • T06V7VOF MASHPEE II <br /> DATE Mw�c1 4 D, T-ID/3 ,O/ <br /> Expiration Date: 31 _ l 'T <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 /> adlt��.e l7�-�'�•r C.a DBA is conducted at <br /> Business Location: 13 Ge-4s.- ST X-g's< miq <br /> Business Mailing Address: 1; C«I"a-, St `+�5�7 e� M� OL&L(f <br /> Business Type:CO-13(1112" Business Telephone: !17—`1117 <br /> Home Phone: <br /> by the following named persons: <br /> FULL NAM'Ep / RESIDENCE <br /> �� ? Ceo.-�� e <br /> 2k., 13 Cet . % f MtS�{.1 C. K� <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 /> axes as required tinder law. <br /> 'Signatmtre of authori d agent "Signature of authorized agent <br /> 671 -20 - 7k 55 — <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME:,&N 4 OLoo.,. r/Y TELEPHONE NUMBER: 4f 1 9 ' � <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 BARNSTsU3LE ss DATE 3 /2a•PJ/U <br /> Personally appeared before me the above-named DtArO ID %9L-00" 6--1 GL17 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 /> Signed JOS —RA CCNEIII,JR <br /> g e y Note Publi <br /> • tMW�y Comm TH 0 W�9S�ONYCfiTT <br /> _ pgepglppydPublic <br /> SEAL <br /> Commission Expires: <br />