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w, BUSINESS CERTIFICATE#06%A l <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWNOFMASHPEE DATE R6 air I D 6 <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 /> l PvL 11 Mtd DBA Ue t 9N ti S Sr-4p110Idq is conducted at <br /> Business Location: -3oa, QJ MAS�gi1 7 r <br /> Business Mailing Address: S atn <br /> Business Type: C"Q2kBusiness Telephon e: <br /> by the following named persons: <br /> FULL NAMESIDE,�CE <br /> ym\ Rola t+ yCl� Rtlit( +S --,GD wl„iooth Rd MY15H Pete �F <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 /> `saxes as required under law. <br /> *Signature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency 1' <br /> NAME: (iz0 p I L U2t 1 f�(Yt�s S TELEPHONE NUMBER: 5t Uu `I 7 7 55U) <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 II__ <br /> BARNSTABLE ss DATE . Y , o <br /> t <br /> Personally appeared before me the above-named ( I fg,i Y1 1 e t ,t`,.J 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 /> Signed 1(,Wdm <br /> Notary Pu <br /> sFa Deborah F. Dar <br /> n NOTARY PUBLIC <br /> Commission Expires: <br /> Commonwealth of Massachusefts <br /> , <br /> My Commission Expires July 24,2009 <br />