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w1 BUSINESS CERTIFICATE#06 _27 THE COMMONWEALTH OF MASSACHUSETTS • TOWN OF MASHPEE DATE Expiration Date: December 31, 2010 In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the undersigned hereby dectare(s)that a business under the title of ��y� LEATfiFic'$ D13Ais conducted at Business Location: ;92 t9.)(ogg Business Mailing Address:�2 i Business Type: (,QUCK//VP Business Telephone: 1;/J - 15A03_- Ll e by the following named persons: FULL N E RESIDENCE Home Phone: I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state Des as required under law. *Signature of authorized agent *Signature of authorized agent **Social Security Number(Voluntary) or Federal Identification Number In case of emergency NAME: TELEPHONE NUMBER: *This license will not be issued unless this certification is signed by applicant "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. The Commonwealth of Massachusetts BARNSTABLE ss n ' DATE 3 3a-66 Personally appeared before me the above-named�'� �` LPc, P rS and made oath that the foregoing statement is true. 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 each four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. Signed • SEAL _ otary Public Margaret C. Santos - N OTARY PUBLIC. Commission Expires: Commonwealth of"Massachusetts My Commission Expires Sept.24,2010