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i <br /> BUSINESS CERTIFICATE#073 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> ;• TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2011 <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby de <br /> clare(s)that a business under the title of / (� �y <br /> +�11\\'1.1� nDBA C I I Y�bY8 +f OiZ D�()�/C6YIJ2.tt.�J is conducted at <br /> Business Location: 1 V� ``o(A. I���,,,tjlI�pyl,t((^ -by - I v lG c 1 f&e f n <br /> Business Mailing/Address:: M V l� I.UAD�t -0-y� �USu,ye6 <br /> Business Type: N5'lY U.LA l Dy-1 Business Telephone: <br /> by the following named persons: <br /> FULL NIWE <br /> JD3 Old IIDa Or , Mli <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 /> axes as required under law. <br /> low <br /> Signature ofa'GKorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> *This license will not be issued unless this certification is signed by applicant <br /> "Your social security number will be famished 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 <br /> Personally appeared before me the above-named M£.( GCfd and made oath that the foregoing statement is <br /> true. <br /> A cert'rc to 's ed 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 o long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> qq ,. Notary Public <br /> SEAL <br /> —A }J./ <br /> Commission Expires: <br />