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BUSINESS CERTIFICATE# 10-p ) If THE COMMONIVEALTH OF AIASSACHUSETTS P • TO IVN OF MASHPEE DATE Expiration Date: December 31, 2014 In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the undersigned hereby declare(s) that a business under the title of �l11/I✓iflS/ f.,•�/1/G DBA 77 is conducted at Business Location: 7— &8/'.." Business Mailing Address: %c��i��J'!!1 ��y tl�Jt—�(�� /� Z%f/� 6.0;e,75 /: Business Type: e7— &;5y Business Telephone: clw ' Home Phone: by the following named persons: / FULL NAME (� RESID CE �j o S�7 �G.t/B/C 2>',4A,' I certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state [as returns and paid all state res as required under la * tgnantre of autho ' ed agent *Signature of authorized agent **Social Security Number(Voluntary) or Federal Identification Number In case of emergency NAME: TELEPHONE NUMBER: Alarm Company: *This license will not be issued unless this certification is signed by applicant **Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. The Commonwealth of Massachusetts BARt\'S"TABLE ss DATE /Z) Personally appeared before me the above-named-741 )2W 4 S f 1. A/Z AJ t'a a and made oath that the foregoing statement is true. A certificate iss 'ed in actor cc wit is section shall be in force and effect for four years from the date of issue and shall be renewed each four,years th r so long as s c busi shall be condu ted and shall lapse and be void unless so renewed. �gned ' I oto SEAL COMMONWEALTH OF MA.48ACt11iiETfB My r"Mi Com6itmpb� s: