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BUSINESS CERTIFICATE# t0- 0.3 O <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE p <br /> DATE 1 � ` 2.S ` Dl <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 <br /> 1 nC,��TOr���•• l"A �- is conducted at <br /> Business Location: �3 Cp ��u� J�Act,�u�� VgV�I U-5�®��1'nL DUwW�O`n5 <br /> Business Mailing Address: C2-6 L'(.4 ' <br /> Business TypBusiness Telephone: O$ ' Lr 7 '7 <br /> Home Phone:SO S - 56 3 - :56 01 <br /> by the following named persons: <br /> FULL NAME RE$IDENC <br /> )17 Q-4 CU.,AC< 6- fot'q 1 L LL �eGr,at6 kZ � IL�y t1�S 31 <br /> 1 certify under the penalti of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> axes req t d un er Iv <br /> A41 A <br /> *Si ature of authorized en *Signature of authorized agent <br /> 0 s6 - Lr& - 6 r Iq <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency p / <br /> NAME: tuD a. 0 (�11 f 0 ACa TELEPHONE NUMBER:5dS' 6 <br /> Alarm Company: P41(,e.r'A: L A 6_,,- w^ <br /> *This license will not be issued unless this certification is signed by applicant <br /> j "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 <br /> BAI2NSTABLE ss ��N DATE r 1­7 <br /> Personally appeared before me the above-named A-A.) `] Q.4`1 and made oath that the foregoing statement is <br /> T <br /> true. <br /> A cc ate issued in accordance it this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years he eager so long as uch bus ne shall be conducted and shall lapse and be void unless so re ewed. <br /> Signed 0 . <br /> • t t ` <br /> SEAL Nota PuaC <br /> ONWEALYH OF MASSACHUSETTS <br /> g§igtp xpires: <br />