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r <br /> BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE <br /> Date: \l- <br /> Expiration Dater VIU✓h►iMb 3,') do(Y <br /> In conformity with the provisions of Chapter 110, §5 of the Massachusetts General Laws, as amended, the <br /> undersigned hereby declare(s)that a business under the title of <br /> Business Name/DBA: Elfstone Silver& Gold Corporation Name: <br /> is conducted at Business Location: 19 Central Square Certificate No. 2010-030 <br /> Business Type: Jewelry Store C <br /> New [J Renewal [d commercial [ ] Residential [ ] Email Address: £f—fS t d,+ J (•a+t a`'�&zeQ®r�t"`6 ["'GD✓r <br /> Business Mailing Address: PO Box 592 Mashpee, MA 02649 V <br /> Business Telephone: 508-477-1888 Home [4ell [ ] Phone: 508-563-5609 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Andrew Groae <br /> . r I cc ify unde <br /> the pen t es of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all to t xes a requi a under law. <br /> A-. p �6;L- <br /> *S gn ure of authorize ag nt **Social Security Number <br /> *T Is license will not be issue nless this certification is signed by applicant or Federal Identification <br /> Number(Required) <br /> In case of emergency <br /> NAME: Mde-a11ti5 R TELEPHONE NUMBER: <br /> Alarm Company: 6'C tZ e- Mo- 'Wt <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax <br /> filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or <br /> revocation. This request is made under the authority of Chapter 62C,§49A Massachusetts General Laws <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE: ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing <br /> statement is 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 <br /> renewed each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> i <br /> Signed Notary Public <br /> Commission Expires <br /> J <br />