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BUSINESS CERTIFICATE#0710 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE /�/jf <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 <br /> -deeclare(.ss)�that a business under the title of <br /> l/Ll <br /> � YSW 11{t�/YL 60geAlIV` DBA r�/ �dwj /tom is conducted at <br /> Business Location: -01 MH1!1 1114 De�� <br /> Business Mailing Address: 01 APA' /T 004e /?Qjt 14 . AdA O7 , L y <br /> Business Type: !30014 1-26/041IC Business Telephone: 50e- xkl6 f <br /> by the following named persons: <br /> 41 �N FULL NAME RESI ENCEE��" <br /> / 6T,r�Cs t r> a,dl n•h /�/1j <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 /> Oes,a/s rrequired under law. <br /> O <br /> *Sig tur f authorized agent *Signature of authorized agent <br /> 0'`f, 33311 t 71 <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 taw,Chapter 62C,Section 49A <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE Q 00 <br /> Personally appeared before me the above-named% and 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 for ars thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> eed <br /> � - U ANN GOVONI <br /> Notary Public <br /> " ora ERlirea <br /> SEAL 18.21119 <br /> Commission Expires: <br />