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r*- BUSINESS CERTIFICATE# 10-C <br /> i <br /> 711E COMMOMVEALT H OF MASSACHUSETTS <br /> • TO MV OF MASHPEE ��1('��� <br /> DATE i `I s�Lv <br /> Expiration Date I ecember 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 tinder the title of <br /> T7 <br /> SA0 i I - !V DBA is conducted at <br /> Business Location: MAS H P E <br /> Business Mailing Address ) -S7 P-,tE T YS ISS Q( Q <br /> Business Type&TE` ET JEtL/�C� Business Telephone� <br /> 7� <br /> Home Phone:-7-7 f,- 2-0i — V � 08fr � � gZ <br /> a 02 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> BRAofio2p LAKUm t 0 "LL&w A C- 611LODLTJ 'A/x IA W5� � <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 as required under law. <br /> *Signature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> 6 <br /> I A n /fin In case of emergency t ( L G <br /> NAME:LV P,I /I'//Q�(-t / TELEPHONE t BER:S09 <br /> Alarm - 0 Company: (-AV-P— <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 /> j The Commonwealth ofMnssachusetts <br /> BARNSTABLE ss � L DATE <br /> Personally appeared before me the above-named A,;-F:,T_4 t� `` A k ukt and made oath that the foregoing statement is <br /> p <br /> l Ve <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 y is <br /> thereafter so long as such business s II a nducted and shall lapse and be void unless so renewed. <br /> Signed <br /> SEAL' Puik CC�rOHWEALTH OFF <br /> t s: <br />