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BUSINESS CERTIFICATE#07 -Na <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE 1 - a y - J <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 declare(s)that a business under the title of <br /> DBA is conducted at <br /> Business Location: <br /> Business Mailing Address: Z9 r//j Q P&/ <br /> Business Type: 1111; frig ld/2 �Orppts7p,, Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <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 /> gnature of authorized agent *Signature of authorized agent <br /> 0(1 S�11 7/ <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 fumished 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 1 - aK- ate, l <br /> Personally appeared before me the above-namedand 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 <br /> efour <br /> years thereafter so long <br /> as such business shall be conducted and shall lapse and be void unless so renewed. <br /> l <br /> SEAL Notary Public <br /> o° ar <br /> M <br /> 9ar et C. SantosNOTALIC Commission Expires: <br /> Com oRwealh of Massachusetts <br /> ,Cmmission Expires Sept.24,Pot 0 <br />