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t BUSINESS CERTIFICATE#0549(� <br /> THE COMMONNIEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2009 <br /> f the provisions of Chapter one hundred and ten Section five of the General Laws as amended the <br /> In conformity with p p , <br /> undersigned hereby declare(s)that business under the title of <br /> 2_'(Je^a^Q \\S DBA ( � is conducted at <br /> Business Location: 4V Oy�✓'� lea-, 1�� IMS t�o� 6 ( 4 <br /> Business Mailing Address: ' 0 D k . o c�' b <br /> Business Type: ¢Business Telephone: !) " Ll r? Y <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> 1M <br /> Home <br /> 1� <br /> Home Phone:_A b( 7 T 3 Y <br /> rtify 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 /> eAreired nder law. <br /> Sigorize�dlagen *Signature of authorized agent <br /> Lf <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 p j I DATE �j —jl _6 5 <br /> Personally appeared before me the above-named t y\4 I-` .P l('�'(/loa V� 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 /> A Nota <br /> Deborah F. Dami <br /> NOTARY PUBLIC Notary Pohl, <br /> COMMWIWeafth of Massachusetts <br /> SEAL = . My Commission EXPires JUIy 24,200 <br /> Commission Expires: <br />