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A <br /> BUSINESS CERTIFICATE#_2D/0^(R-( <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE IJ /rl'/ ' <br /> Expiration Date: ( �b f I a 0/ <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby de (s)that a business under the title of <br /> DBA �� r P - R UuP is conducted at <br /> ySGnJ Dvhe) Cdvr � �015� �e M ODN9 <br /> Business Location: 1 <br /> Business Mailing Address: '3 cA�° D U n,* o U rYKA�kJ 1\46 Q <br /> D/l <br /> 9 <br /> Business Type: ALQyl3. Business Telephone: 7 Z 'f77 - 7766 <br /> Home Phone: So ` <br /> V-7 - 3723 <br /> by the following named persons: <br /> y�� PnlnyLNAMIj� OUh✓1 S�RFwS <br /> �� 113"jnf) CrnQV� V I�,,G,) '(Jt'e I��4 <br /> �U_ <br /> j 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 /> tax�u Mer law. <br /> •• ignature of authorized agent 'Signature of authorized agent <br /> ODiI- '?i � - 7599 <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 famished 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. Trus request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss C DATE <br /> Personally appeared before me the above-named v and made oath that the foregoing statement is <br /> we. <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 fo y so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> 1 <br /> Signed <br /> cow ' <br /> Notary Public <br /> • SEAL c. .°vt.,_ -_ <br /> CommissiAll"re., IF <br />