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o7 -30 <br /> BUSINESS CERTIFICATE#0 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 201 <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 /> WL� -;,y, �/ S Wt i L1 DBA py � EVVI&1 0 En(/ is conducted at <br /> Business Location: �)Eeo cS✓t Z—A) me <br /> Business Mailing Address: Or) j,t )L 6Q"i 5 Lt Lt l) • ' C V t�2EE '41 tg <br /> Business Type: G s -/ Business Telephone: SOS- • 60 - /4& <br /> by the following named persons: <br /> .1 FULL NAME RESIDENCE <br /> HaC7_ti7, 5 t4.r t ill CIA vl.L f ms t- 1?nUe - <br /> Home Phone: 50(-h— -s7 y,q'-7 p - + <br /> I certify under the penalties of �4r I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> xes required on er I <br /> * ignat 5,e ,aut or *Signature of authorized agent <br /> �!_ o - 6y <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <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 subiect to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth ofMassaehusetts [� <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named �. �h/I � and made oath that the foregoing statement is <br /> [me. <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 four years thereaffelong as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Notary Publt <br /> SEAL - <br /> Deborah F. Dami <br /> NOTARY PUBLIC Commission Expires: <br /> Commonwealth of Massachusetts <br /> My Commission Expires July 24,2009 <br />