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BUSINESS CERTIFICATE#06_�6 <br /> THE COMMONWEALTH OF MASSACHUSETTS 77 <br /> • TOWN OFMASHPEE DATE �rGn / d <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 /> u 'I �Y160, t/-r r:.DBA J )ItnM Y�r\ �5� Y1 is conducted at <br /> fu.f <br /> Business Location: ' '7 0 Wd P F1 6,3 W `a , V/c ,Z 7XI5 <br /> Business Mailing Address: l /o 7t 'J � Q 2foq <br /> Business Type _&'-'+3U voV1+— Business Telephone: O <br /> by the following named persons: <br /> na <br /> rneS UL _sJtLl1 769 <br /> lc9 <br /> Home Phone: O_CC I99�51J9b <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 /> 0 / l - 60- ./f7& <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> / In case of emergency "C-C Zgr fo <br /> NAME: {�ISGL �U�IC t` TELEPHONE NUMBER( ®oS) 17':7& <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 subiect to license suspension or revocation. This request <br /> is madeunder the authority of Massachusetts General Law,Chapter 62C,Section 49A <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE 9- apo 6 <br /> 1_ <br /> Personally appeared before me the above-named ,��=t'Mt'S "Q yF IL and made oath that the foregoing statement is <br /> true. - - <br /> A certificate issued in accord a with this section shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four yea thereafterong as us' ss shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • ry <br /> Margaret C. Santos <br /> otaPublic <br /> SEAL �,Q,q NOTARY PUBLIC <br /> w1V Commonwealth of Massachusetts Commission Expires: <br /> my Commission Expires Sept.24,2010 <br />