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BUSINESS CERTIFICATE# <br /> r <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE r',. 2 2✓t <br /> • Expiration Date: <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 /> Business NamCfDBA:LOBSTCr Tr (�.tre Corporation Name: D F e ri�C S� is conducted at <br /> Business Location: oJf� --��M�S4t t2eP rpteur \ <br /> Business illailing Address: YxoX .3� O C a_6- Mt'� 02363 <br /> Business Type: FIS A (L Q,+u 1/1!A-ILC, OcTV Business Telephone: .b FS -7-S-1 _Z(,00 <br /> Home Phone: 05 Email Address: ,t <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> NIA De L6()LC.4 _ " �Fvdn- sn ANIc6a) NIA <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 /> taxes as requi r <br /> F ►. �� �s - a� 373 <br /> .iahtre f a nze a "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> 'This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> i <br /> Alarm Company: <br /> i <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 subicct to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C, Section 49A. <br /> The Conuuonwenhh of Massachusetts <br /> BARNS-FABLE ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing statement is <br /> nuc. <br /> Acertif ate issued rdance with this section shall be in force and effect for fou years from the date of issue and shall be renewed <br /> each four years t ereafler long as uch business a conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • - Notary Public <br /> SEAL <br /> BSEP F&tt,'J <br /> n COMMONWEALTH OF YASSAdNBETf6 <br /> . � tAFl.anutiaslonF�� <br /> OG00t1i25.�2013 <br />