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f. p� <br /> BUSINESS CER'I'[FICATE# 10- OU <br /> T'HE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE 21 �b <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)Lthat a business under the title of <br /> �S CAD ns"KsC!5 JL9--VIC trS DBA is conducted at <br /> Business Location: 11" L.Od s% L.L,t S I a A1C- rn'a Coln pG€fit VY%P 07-in % !r <br /> Business Mailing Address: SC Y-114 <br /> Business Type: n a Business Telephone: •�;0$ -S 3°)- 31 %4 S <br /> Home Phone: !Ze6- 4JY1- 3a•4 J• <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> DOt\no y. W1c- 17GJt 1 s,1' WIJG uul S "A) t1MASlaPf_� W1A <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 /> AdjKaxes as required under law. <br /> "Signature of authorized agent `Signature of authorized agent <br /> 032 yo15S1 <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: __D on n c„ TELEPHONE NUMBER:'30'if S�r7 '31 Lf 5 <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 /> I <br /> The Commonwealth of Massachusetts <br /> BATUNSTABLE ss DATE Wal I I <br /> Personally appeared before me the above-named DOn^re. 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 <br /> ,�business <br /> �shall be conducted and shall lapse and be void unless so renewed. <br /> L <br /> Signed �, Y 141 , <br /> Notary P <br /> SEAL DWW <br /> ONOTAiiV <br /> �d Commission Expires: <br />