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~ BUSINESS CERTIFICATE#06 — I-,3 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE /R JM .LU O 1p <br /> Expiration Date: December 31, 2010 <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 /� Pgss <br /> PAuu- ,k Fizmcas M. 6,Am15�BA DBA (_�t is conducted at <br /> Business Location: d o l 4(7F ' P/N E t &-PW V r. /V1�kyf}Qr/ F � <br /> P• 9 <br /> Business Mailing Address: 0. 410 �7qS M_Ai MA L92 7 <br /> Business Type. Business Telephone: Oak 39 <br /> by the following named persons: <br /> FULL AME RESIDENCE <br /> — ?AU1 rl 13AaaA /ol' 4�1� Pin/ _VF <br /> GRANGES M. C2AMi3ARRA 1t H N <br /> Home Phone: <br /> 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 /> required under law. <br /> � I <br /> Signature of rized agent Signature of authori agent <br /> O �Z_ �S9- Zoo <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: A.5 AZDVE TELEPHONE NUMBER: SD4E;3I 2g33 <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 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 DA4 <br /> Personally appeared before me the above-named ?CJ � Q CM bQQP\QAC. 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 tlo long as such business spall be c nducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • otary Public <br /> S4 Margaret C. Santos <br /> A arc-aoIo <br /> NOTARY,PUBLIC Commission Expires: <br /> Commonwealth of Massachusetts <br /> Ny Commission Expires Sept.24,2010 <br />