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BUSINESS CERTIFICATE 10-�3 I <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TO INN OF NTASHPEE <br /> DATE <br /> ExpirationDate: 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 <br /> �/(/that a business under the title of <br /> V USQGP. DBA is conducted at <br /> Business Location: 'Q'5 VC4)2lA , M rt <br /> Business\flailing Address: <br /> Business T}'pe: P f"l)IC�. Business Telephone:(S�_.� <br /> Home Phone(-S[)In-) q, <br /> by the following named persons: ' <br /> 1 L L NAM Y CJ �� ASIDE E <br /> NI)CAVIr a5 <br /> O' I�G Sh ►�eP <br /> I certify under the penalties 9f Perjury that 1, to the best of my knowledge and belief, ve filed all state tax returns and paid all state <br /> ax as requ' under IV <br /> 1VV\ <br /> *Signatur of authorized agent ignamre"I <br /> autl orized 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 Commonwealth of Massachusetts <br /> BAIL\STABLE ss DATE <br /> Personally appeared before me the above-named Ep-mcj 0 A W-1 40-/ and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in ac rdance with this section shall be m force and effect for four years from the date of issue and shall be renewed <br /> each four,years thereafter so long su business shall be conducted and shall lapse and be void unless so renewed. <br /> Signt <br /> • ed I <br /> ® tW�IWI!xpiresj <br /> ryPublic <br /> SEAL OF MA9 <br /> 5ACHUiE <br />