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` 901- <br /> BUSINESS CERTIFICATE#/0-67 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: � 30 <br /> fn 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 /> �p�{ SICzNS DBA '�; VTT -DESIGNS is conducted at <br /> Business Location: G)'LEN JEA<i J� W MAJHT;eE.A 02-(,: 'ci <br /> Business Mailing Address: 916LOJNEAGLE -M t M F1--_. //MA 02%11 <br /> Business Type/: TD�E56Go 6eKV ICES Business Telephonef5-0'3��� --2-990Home PhoncLOM 4:321 -2-980 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> S'A960 H O U AA4P C14 GLt5 t� A6Le Q[Z KAA5H-P-ES MAY d2(A`j <br /> I certify under the penalties of petjur at I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> WZ7der law <br /> :pSignatture of authorized agent *Signature of authorized agent <br /> 2-2-T - q3S - ZZ') <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME:C44A'_LeW iipi , A-tly TELEPHONE NUMBER(-_Ht' 12 0OK- <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 Massachuseus Department of Revenue to determine whether you have met tax filing or tar <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subiect to license suspension or revocation. This request <br /> is made under the authority of Massachuseus General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts BARNSTABLE ss DATE 4- al-aGlho <br /> Personally appeared before me the above-named_SClfwh t' t 4'I447'n A_ and made oath that the foregoing statement is <br /> tme. <br /> A certificate issued in accordance witt this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four year jh/e/reaftelr/rsso tong as such busi ss shall be conducted and shall lapse and be void unless so renewed. <br /> igned <br /> ' <br /> SEAL Margaret C. Santos <br /> Notary Public <br /> 'tv NOTARY PUBLIC of- a4 - -.'0 IU <br /> Commonwealth of Massachusetts Commission Expires: <br /> My Commission Expires Sept.24,2010 <br />