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BUSINESS CERTIFICATE# 10- 3 <br /> THE COMMON6VEAL TH OF MASSAC$USETTS <br /> TOWN OF MASNPEE <br /> DATE <br /> Expiration Date: ecelnbeY 31, 2014 <br /> In confotnuty 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 <br /> DBA is conducted at <br /> Business Location: (('' <br /> Business Mailing Address: <br /> Business Type: "N < 'Pr 1 h Business Telephone: <br /> Home Phone: !j6<iF`— S�-:� —�bJl1 <br /> by the following named persons:FUL —1 \ <br /> V11\L N 4 I 1 C<RES��\ �Cv <br /> I certify tinder 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 /> �es as required under law. <br /> *Signature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME:d_ �� `—QCh 4USS 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 /> The Commonwealth of Massachusetts <br /> BAIL\'STABLE ss \ ' t7�� DATE l-a t- a-o� t, <br /> Personally appeared before me the above-named AL C..�" �e e n 1`">S and made oath that the foregoing statement is <br /> true. <br /> A cert'ficate 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 yea th�erreea�fte�r so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Margaret C. Santos Notary Public <br /> SEAL l NOTARY PUBLIC � _a 4_ a.o �V <br /> IJVY <br /> Commonwealth of Massachusetts Commission Expires: <br /> Commission Expires Sept.24,2010 <br />