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BUSINESS CERTIFICATE#05 '(p <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 /> eA / —/ DBA (�//� / �O�G conducted at <br /> J/ �/ <br /> Business Mailing Address: .iri//7SG1�,�/J �/� <br /> Business Type: - Business Telephone: 6- <br /> by the following named persons: <br /> Home Phone: 5& Y'72 <br /> rt,fykariwUg(; <br /> ties of perju tar, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> es as a <br /> *Signatu *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 ojMDATE <br /> assachusetts An af�fJJ <br /> BARASTABLE ss �nI `f <br /> Personally appeared before me the above-named M�jr(�� l �(�l.{� 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 /> • , Deborah F. Dam! <br /> NOTARY PUBLIC <br /> - - '� COf11111oawulb of Ma55achusetts Notary Publi <br /> s ' "SEAL My COMMN sdph E%PiM July 24,20D9 <br /> Commission Expires: <br />