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BUSINESS CERTIFICATE#05 IV <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 12(28 )2rX�4 <br /> Expiration Date: December 31, 2009 <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 <br /> 1�Avy> Cc> AN l�0l�C� DBA ���� -S is conducted at <br /> Business Location: rn'A_1;:0? E V <br /> A 02i <br /> q <br /> Business Mailing Address: S NVIE <br /> Business Type: j�h10 sO6�kPll '6 Business Telephone: /�7 91-7 1 OS <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> wo � -It> 'tkQFJ: Mia v26� <br /> III <br /> Home Phone: <br /> ertify 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 /> esus required under law. <br /> *Signature of individual By: Corporate Officer <br /> **Social Security Number(Voluntary) - <br /> or Federal Identification Number <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 sub iect 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 /> BARNSTABLE ss DATE Jif 0 <br /> Personally appeared before me the below named auld a LI'17 -Acy) Q 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 /> SEAL c Ma -rgaret C. Santos Nctary Public <br /> .NOTARY PUBLIC � G D <br /> Commonwealth of Massachusetls Commission Expires: <br /> Wy Commission Expires Sept.24,2010 <br />