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n <br /> BUSINESS CERTIFICATE#06 a9 <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 /> DBA /I/j AN/$/ '(6emor A'S-'Oe" is conducted at <br /> Business Location: 1�'j GUM P_('�i'/Z / � j����.�� �/� Q z <br /> Business Mailing Address: <br /> Business Type: __ 21_f 6Business Telephone: <br /> by the following named persons: <br /> F LL NAME RESIDENCE <br /> LyHarSG,et1 '� saw <br /> Home Phone: <br /> I ce7tur/e <br /> r 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 /> xered under law. <br /> LY /�— <br /> *Siauthor ed agent *Si ature of authorized agent <br /> �tZ �73� ©off 3� ki0� <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> /9 In case of emergency <br /> NAME: TELEPHONE NUMBER:S sa <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 �_3 a N-HCo G <br /> Personally appeared before me the above-named�a.m BS r4 kct ✓n and made oath that the foregoing statement is <br /> true. <br /> A certificate i ue .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 thereaft r s long as s h business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • S <br /> Notary Public <br /> SEAL Margaret C. Santos <br /> ' NOTARY PUBLIC C/ 3u a0l0 <br /> Commonwealth of Massachusetts Commission Expires: <br /> My Commission Expires Sept.24,2010 <br />