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J� =� BUSINESS CERTIFICATE#05 $1 <br /> i <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 /> ZIS CLA?K $ ldv3 fie. DBA J79fAA'LA4k r- ?-TW r 06-k-A J, eAlT Cod is conducted at <br /> Business Location: ?S f cF J-J 101AMPK /IA- tl Z 41°f <br /> Business Mailing Address: h-®- Sou 338 006yq <br /> Business Type: K�v+tih�S '�Pyh�aln� Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> J,Y t d C�Acr� ZS� <a9, �l v/vim .. yZsy 4 <br /> —'10YIA <br /> Home Phone: -:508 ,5,3 J - <br /> ertify under the penalties of perjury that I, to the best of my knowledge and belief have filed all st to tax returns and paid all state <br /> es as required unde aw. <br /> Si cure of authorized agent �gnature of auth rized nt <br /> 65 /Z3j_;-0, <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 IL' <br /> BARNSTABLE ss DATE Q-i' 0��7 o?DOS <br /> Personally appeared before me the above-named /aAe, Q..0 Yl 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 /> 'SEA L Notary I u <br /> SEa ��8h F DBrnj <br /> Comm OTARy1 SUC Commission Expires: <br /> MYC"tt WM <br />