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BUSINESS CERTIFICATE # k0-6';L­-7 <br /> THE COMMONWEALTH OF MASSAC$USETTS P <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2014 <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 /> � DBA Y'b/] Ile N LYI&i l e / is conducted at <br /> Business Location: X r9 0/'A 13 4'e 5 rA - k ��C,P A/�A • OZ6 <br /> Business Mailing Address: 30i; OL h Byk stAG le 0 4i "g PP kO L6 yQ <br /> Business Type: QPST,et„eg Business Telephone: 5-b Y,- 117 — L zye— <br /> Home Phone: 5D9'- 36 7.— Z66 <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 /> Ores as required under law. <br /> *Signature of authorized agent `Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <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 Contutonrvenlgt of Massachusetts I <br /> BARt\'STABLE ss P/11 <br /> //�/ DATE <br /> Personally appeared before me the above-named r 11 1 �t /D T) 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 a Fs-ft er soong as sucI_conducted and shall lapse and be void unless so renewed. <br /> C•Signe(. <br /> JOSE { HLc EELU,JA <br /> RI <br /> - Noma,y Public <br /> txlooer 25.2013 <br />