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r <br /> BUSINESS CERTIFICATE# 10-Q S <br /> THE COtYLY 01WEALTH OF MASSACHUSETTS <br /> • TO IViV OF MASHPEE <br /> DATE JtM <br /> Expiration Date: December 31, 2014 <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) thata business under the title of <br /> I r q Y7Ll S / <br /> X . A �t 2.r' Y1 DBA F'eg 0& F-9-0 A k- S is conducted at <br /> Business Location: 13 U,)C ST &t.)/4 Y IM If-5 A /0 ee r ># 0Z6 ZiL. <br /> Business il1ailing Address: 13 too ST w/4 !e W1 A-s A p� FYI A 0Z6 <br /> Business Type: YK69 i (e FOOd Business Telephone: i O 77 7 c-9=1 <br /> Home Phone: Sn q77 V L2-9 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> �ranc/s X /� 1, ei r\ 3 S7- U_­7 ,04 Y WttfShteP yu,41 <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 /> xes as required under law. <br /> X <br /> *Signature of authorized agent *Signature of authorized agent <br /> Q13 6� µ &03a <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: Tr fairei s )k • Ake r ^ TELEPHONE NUMBER: �_496r 6*5 7S/3 <br /> Alarm Company: <br /> *This license will not be issued unless this certification is signed by applicant <br /> "Your social security number will be fumished 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 subject to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C, Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARtNSTABLE ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing statement is <br /> 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 renewed <br /> each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • Notary Public <br /> SEAL <br /> Commission Expires: <br />