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V <br /> BUSINESS CERTIFICATE#06 — S <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <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 <br /> .5ptn-f{J CA96V i tpygCGcr \\ria !45.FADBA NC is conducted at <br /> T <br /> Business Location: C7 J U�i 5`�2 i )m p5 p Y r N d Z.c q Ci <br /> Business L. F <br /> Mailing Address: V? 1 dL't) M i t.>Gc �0�5 r (2� pL_r_,o �. t h (wp GZ.S3(- <br /> Business Type: C's p t+Z S 6.Lci.AST N Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> rZ var+ G2AD1 x 17 ! o Lb C' <br /> 'rnt!�' GoP V"N CT/Zf��� ,� E,.tT �Lw�t�t �� 1MA 01-531 ' <br /> Home Phone: S a — S 9 8 — 02 S <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 /> �s as required <br /> 'under law. <br /> *Signature of authori`zeeed,\agent *Signature f authorized a tot <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency Sc8 <br /> NAME: TELEPHONE NUMBER: :5 6a6S <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 '5.4eJen O. 6r�j'i DATE 131 <br /> ` <br /> Personally appeared before me the above-named Yr\Goth sA Ht rad 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 /> SigdedV <br /> Notary Public <br /> SEAL U Margaret C. Santos <br /> NOTARY PUBLIC <br /> Commonwealth of Massachusetts Commission Expires: <br /> Ny Commission Expires Sept.24,2010 <br />