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r BUSINESS,CERTIFICATE#04-�b <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 /> r DBA A r' I �'� Lrn; aT is conducted at <br /> 1M <br /> Business Location: rl.S4p I G'N1? 0,7n n/') ( 11lrE,� 4,g e1),) ( !�} <br /> Business 1 <br /> Mailing Address: <br /> /s: C7 � I?'�GIi,'t S--Z— 'Tzr 1t7 tn.�n0 !�/n�4-6 <br /> a J1S <br /> Business Type: ' �1 / / Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> SCDkiPI�' v? 4n ' l� Y�Cq �t f �neryl /ltd <br /> Home Phone: <br /> certify 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 /> s as required under law. <br /> -'�.�/iii/ ✓UI �lj (`(� 7>`'/ FSi—r'/rrh'� <br /> *Signature of indivi al By: Corporate Officer <br /> oV"j -L� (o`ltl� <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 <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss f n /Q, DATE ✓; UQ� <br /> V � _ <br /> Personally appeared before me the-below named Vand made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this sectionshall be inIce 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 /> Nota ublic <br /> SEAL ECo�on%Ncalth <br /> IA L SCO 1..1. n <br /> n Public �l O�bd/_ <br /> ofYlassuchu;cus ���issionh:cpiresCommission Expires: <br /> =1. <br />