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MAR-10-2011 16:46 FROM: M:iBBB3093969 P.212 <br /> RUSINESS CERTM, CATE 11 1 7- ' 6 <br /> • THE COMMONWEALTH OFMASSACHUSETTS p <br /> TOWN OF MASAPEE <br />_ DAYS <br /> Fxpiration Date: tl <br /> In conformity with the provisions of Chapter one hundred and ten, Section Five of the General Taws, as amended, the <br /> undersignad hereby devlare(s)that a business under the title of <br /> RusinnssNomdDRA: S2ar.. 6JiYt7t.>e CaronwaficnNamo: 11r1¢_ 1,Y),C l0-a.I &A-VX 6:rtA-'I(e <br /> �Q <br /> '�_1 ( i ! <br /> is conducted at Business Loeu lion: 18 :5_+ LA- .� �.�S"C>t` e �4 Commarcial�Resideullal� <br /> Business MuiltngAdd ressh N) ;2nx 8-4(a IM--fir e-�, WA nZfO4q <br /> Rusinaxe Typc: 1/n �_ k ES`ki5r.L S ' Business Telephone: �D'- 4SD' ZZg� <br /> New V1 Renewal ( )RantoPhone: Address: rnuTcotVt <br /> by the following named persons: <br /> Owner Name Owner Residcnco <br /> Fb,-6,WlV� 1 csNu 03661 t� <br /> 1 certify under the penalties of perjury that 1, to the best of my knowledge and helief,have filed all state tax terms and paid all state <br /> axes%;required under law. <br /> lQq:�C — zo 011sgef3 <br /> • •Signature of authorized agent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> i <br /> j "This license willnal be Issued unless this certification is signed by applicant <br /> its ease or antergency p ^r <br /> NAME:—F-S�� ._ _ -rELEPHONE NUMBER: (0 O �L S <br /> ` <br /> Alarm Company:- <br /> --Your social security number will be famished to the Misachusetts Department or Revenue to detemnno whether you hove mel lea Jilin&or tax <br /> payment obligations, Liocnseos who fail to correct their tion-filing or dellpquency rYlil lie s hlect to license munponsion or revocation. This niquosl <br /> is made under the au[horay of Massni peas Qrnaral Law,Chapter 62C,Section 47A. <br /> The Commomveardr ofMasenehusarls <br /> BARNSTABLH s DATE`_-. <br /> Personally appeared before me the abovenamcd v_MWI!_C Y and made oath that the foregoing statcmmt Is <br /> true. — <br /> A certarcate issued in accordance with this section shall be in force and effect rot four years from the date of issue and shall be renewed <br /> each four wf6 thereafter so <br /> lla O business sh be conducted and sholl Iapw and be void unless so renowtd. <br /> sign t,U-Ua.�fL `.�• <br /> Notary Public <br /> SF•AI. <br /> Commission Expires: <br /> • dOSFlM L. 3 <br /> l <br /> F <br /> b oo <br /> COMMONWEALTH O <br /> cenrnsn� <br />