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IR <br /> BUSINESS CERTIFICATE#05�-4 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE 1 I • "t l LQ�0,S <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 /> !c A n4 Isl DBA �eA,(��\(�l1��(),��� - �(� is conducted at <br /> Business Location: t J ,t1`YVILLl1 ��I�is Na(W . 1 I Ilk1YCoLI11L_ ffVk. <br /> Business Mailing Address: ,XyK_Q — Q '7 9 <br /> Business Type:&k(_ � Business Telephone: 6R ,zO� � I <br /> by the following named persons: <br /> L NAME RESIDENCE <br /> IA� ( > rye_ L�IcaVQP,� I CC"- SY1 � <br /> OQULA <br /> Home Phone: s7c�� I-oo/0 <br /> rtify 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 /> *Signature of individual By: Corporate Officer <br /> t—'S�, �eb -a�U I <br /> **Social Security - umber(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 subiect 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 lc�- (/-0 <br /> Personally appeared before me the below named / �6'eOV C, 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 /> Si d <br /> Mwo"C. Sanas <br /> SEAL o NOTAMPU6UC taryPublic <br /> � '�' Commission Expires: <br />