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BUSINESS CERTIFICATE#05_�Jq <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 3 V7 105- <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 /> E cl Vi.r�\ C Ic t i c't I DBA S?_r VI C e S is conducted at <br /> Business Location: 5`i 11km ((r,L br McA 1 l� AAA o _((,o q j <br /> Business Mailing Address:.'3n '-k-1V1`CCIt N' Tc- M A - 02�+ 1 1 <br /> Business Type: ►_+�,,,�r t.,l;,�¢,(lk,s Business Telephone: _!5--6F 'FC)a -7 75_0 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> f�war -� 0 1 -'[� i. >-` 3 5 1�;n tdr <br /> Home Phone: �O F e 3 1 3YJ 6 <br /> rt fy 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 /> s as required under law. <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 IIII DATE MO,V a5, aoos- <br /> Personally appeared before me the above-named tiC1l'..LJO-r;d /"r- (�//C ✓4 iG✓i 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 /> • ZMA <br /> Rll:\ L.SCOTT\otaPl /I <br /> Commonr�culur of v>assachusetls. �Notary/Pu lic <br /> M� Commission Gspires <br /> SEAL - - March 21.2006 yy / <br /> Commission Expires: <br />