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BUSINESS CERTIFICATE# 10- C� <br /> THE COMMONIVEALTH OF MASSACAUSETTS <br /> TO PVN OF MASHPEE <br /> DATE <br /> Expiration Date: <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Ld`v,as a�ded ,'the <br /> undersigned hereby declare(s) that a business under the title of <br /> / DBA ayin z,t is conducted at <br /> Business Location: 4' ���s ��V /'��5�,(�/-2 2 1%17,,'4 • &V-q <br /> Business Mailing Address: /o C7'%G/�S l.�O�t7 11-7a A -2-� �///� nn ��G��//(;ef <br /> Business Type: a[A76 (/�®I/�h� Business Telephone: 7�"�— �O'/�. / (O(o C-,) <br /> Home Phone: j08 1f77— �✓�(Jo2 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> �hz��,vatirP e- � /�h� /o f/G;�r lfi�ti ✓��s�G� <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 /> axes equired under law. <br /> *Signature of Athorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: �G 61 - / o TELEPHONE NUMBER: 5-0,9-q;77- 9?56a <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 Couunonwealth of Massachusetts BAIL�'STABLE ss /����11 / DATE o <br /> Personally appeared before me the above-named _SZeK it QL,1l1e- A\/ice 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 ereaRer so long as such bus ess shall be conducted and shall lapse and be void unless so renewed. <br /> Signed �t <br /> • �'i —o Arty Tyo ry ae Ett1;JR <br /> e <br /> SEAL COMMONWEALTH OF wtsa�cttu� <br /> ����ComrnisOiEioQ&4pj0�s. ; <br /> t <br />