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BUSINESS CERTIFICATE# 10-C�J <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Fxpiration nate- DpretuhPY 37, 2074 <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 2 <br /> (1 kAL.t)t S 5 �✓,, C . DBA y n3 is conducted at <br /> Business Location: O V v 1 CJ r � �y' U��� e t X A n k-.-,�1� <br /> Business Mailing Address: O k W 5• _ `� 6'�' <br /> Business Type: ROs ��-�-�1 Business Telephone: <br /> Home Phone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Alt' VA "cllZlir, YhA� <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 /> *axesas <br /> required under law.. <br /> *Signature of authorized a enI "Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> *This license will not be issued unless this certification is signed by applicant <br /> "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 subject to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> �e��' �1or�dct <br /> BARNSTABbE s II// �7 c ` _- DATE—tom <br /> Personally appeared before me the above-named, V 111 Il- Y.WJC-�C �1 ri4., 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 the after so long as We Y siness shall a conducted and shall lapse and be void unless so renewed. <br /> Stg <br /> • u-u n » `/Z <br /> Notary Public - <br /> SEXY'.LUANNE BURKHOLDER ^ <br /> Comm#DDOB5.3646 <br /> ` <br /> Expires 2!62013 Commission Expires: <br /> �® <br /> Florida Notary Assn•Inc <br /> .. <br />