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BUSINESS CERTIFICATE#05,A0 <br /> THE COMMONWEALTH OFMASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE Z' 67✓ <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�ddeeclare(s)thattaa business under the title of / <br /> �Q/�✓3�Gt � / G✓ �✓y \DBA /�SG�✓ l�``��G�� is conducted at <br /> Business Location: �� CI�✓�� (fit /��lr C� /✓ ✓n�3S t'� � o�6y/c <br /> Business Mailing Address: -5W22;7 p <br /> Business Type: AW—C.. ZF5_77Z"7­1!�- Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> 1D0l✓,1ld -74) 613,'z ��rt , y1vl7- 7 1�').Y1Ie� �-n 11- <br /> Home Phone: . S�rY �✓7 7 <br /> * <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 /> es as 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 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. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss 7�\ / DATE <br /> Personally appeared before me the below named JCS fG 1 I CP PCZ-77 k r eand 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 /> Signe <br /> PAW <br /> SEAL MART-f\ L.SCOL 1 <br /> \omn Public <br /> Commo,calthof Massachusetts. <br /> M� Commission Lspims Commission Expires: <br /> ptarch 31.2006 <br />