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rJ <br /> BUSINESS CERTIFICATE#05 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWNOFMASHPEE <br /> DATE <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 /> DBA is conducted at <br /> Business Location: <4 0J �c - <br /> Business Mailing Address: 6&Z27 5,D S,gtl D col ,C /J -7 <br /> Business Type: / G/)-C'" re. _ Business Telephone: `]�i��� ���Q � <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone: <br /> •mfy 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 /> s as required under law. <br /> * ignature of individual By:Corporate Officer <br /> *'Socia— l�ty umb u;Ary) <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 subiect to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. /�f 'p <br /> � 7 The Commonwealth ojMassachusetts <br /> E ss DATE <br /> Personally appeared before me the below named and made oath that:he foregi�ng 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 L <br /> 5 <br /> Public <br /> Notary <br /> SEAL A <br /> Commission Expires: (J <br />