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J <br /> BUSINESS CERTIFICATE#06" � <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE �' pc—Ola <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 /> DBA is conducted at <br /> f <br /> Business Location: �p <br /> Business Mailing Address: <br /> Business Type: O� Business Telephone: <br /> by the following named persons: <br /> FULL NAME <br /> ,( (�2 ,2Z �1 2CL4E L <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 /> taxes as required under law. <br /> Signature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> �n p In case of emergency y- l <br /> NAME: I T I I c6la'd S 1 I IIZ 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 of Massachusetts <br /> BARNSTABLE ss DATE O <br /> Personally appeare' before me the above-named ���- , l��.� �, 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 longsuch bu ess shall be conducted and shall lapse and be void unless so renewed.. <br /> Signed <br /> Notary Public <br /> • SEAL wm,6zhnswKk3wsswtuoo4n <br /> gleantpossm to ype"uowtuo0 � <br /> a!Ignd Ne10N ommLission Expires: <br /> N33N30 'V IONVO <br />