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r BUSINESS CERTIFICATE N <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: 4/3a <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 Name/DAA: 66"rC&,07 �i!A.O/./Corporation Name: is conducted at <br /> Business Location: 4 f a it 9 4 <br /> Business Mailing Address:: ®��74 r 3S <br /> 13usiness T ape: t"j /.t i�.�e,� Business Telephone: -<D E — -7-7 <br /> PI <br /> Home PG, d 7= )7 Email Address: <br /> by the following named persons: <br /> q Owner Name Owner Residence <br /> [n d0 C St dlf.r'/I G/i C <br /> I certify under the penalties of rjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as required un r In <br /> `Signature of authorized agent "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 /> Alarm Company: <br /> s"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 subiecl to license suspension or revocation. This <br /> request is made under the authority of Massachusetts Gcneral taw.Chapter 62C,Section 49A. <br /> Tire Commonwealth of Massachusetts <br /> 13ARNSTAI3LE ss (n� / DATE -y ZO! <br /> Personally appeared before me the above-named 'nd('y$e� ^� �� and made oath that the foregoing statement <br /> is 11'UC. <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the date orlssuc and shall be renewed <br /> each four years thereafter so long as sue u.Ness shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Not:uy Public <br /> • SEAL JOSEPH LL.MAZZUCGNELU,JR <br /> n I COMMONWEAim Pu 5tqVK)3ETT9 <br /> My Commission Expires <br /> Oct <br /> ober 25.2013 <br />