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i <br /> BUSINESS CERTIFICATE#066 <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 /> Dyh- DBA 6 is conducted at <br /> Business Location: <br /> Business Mailing Address: <br /> Business Type: N)a-� Business Telephoner <br /> by the following named persons: <br /> FULL NAME RESIDENCE`S <br /> Home Phone: o}77—t,'��q <br /> 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 /> es as requir er w: <br /> *S' afar of autliized a t *Signature of authorized agent <br /> **Sociaf Security Number(Voluntary) <br /> or Federal Identification Number <br /> l In case of emergency <br /> NAMEG--a— TELEPHONE 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 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 ofMassaehusetts <br /> BARNSTABLE ss DATE Qrn� 31 'DdOV <br /> Personally appeared before me the above-named lir u kC non 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 s u business shall be conducted and shall lapse and be void unless so renewed. <br /> igned <br /> Mapgaret`:C. Santos Notary Public <br /> SEAL <br /> '� NOTARY PUBLIC Li Ay <br /> y Commonwealth of Massachusetts <br /> s Ny Commission Expires Sept.24,2010 Commission Expires: <br />