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r <br /> BUSINESS CERTIFICATE#05-.53' <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2009 <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 /> S . DBA is conducted at <br /> Business Location: <br /> Business MailingAddres our �0 <br /> Business Type: Business Telephone: <br /> by <br /> the following named persons: <br /> Home Phone:,5-D �z7/ 5 z-7 Z, <br /> 0rtify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> required under law <br /> W� �„_'� <br /> ,,Signature of authorized agent - *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <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 DAT S <br /> 1 /� J1 <br /> Personally appeared before me the above-named J.DQJ ' '`'tAl-,, ( 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 four years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • MARI FA L.SCOT I. <br /> Notan Public <br /> Commoneealth of Massachusetts. - �Nm, ubc <br /> SEAL My Commission ENpires <br /> March Sl.2606 ✓ <br /> Commission Expires: <br />