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BUSINESS CERTIFICATE#05. 1 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATEAC,_ i� dt2)�_ <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 dec are(s)that a business under the title of II f <br /> d 12�� t'Isrt (.11f�• `\-/ DBAI C h Ct f t L�f ��JThi( 5 is conducted at <br /> Business Location: d"3-7 (- ref EVtC_ Vs <br /> Business Mailing Address: SRhv 0L aod'e- <br /> Business Type:iglg l tr lt!S A)d"9c, 6�d z Business Telephone: f?)? 3� •- ?�1 a— <br /> by the following named persons: <br /> FULINAME RESIDENCE /, <br /> Home Phone: `iCJ�- SrYyi!of <br /> 10rtify under the penalties of perjury t I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> quir d under law. <br /> C <br /> tgnature of auth 'zed get t *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 sub iect 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 DATE O DCS <br /> _5V <br /> Personally appeared before me the above-namedS 1Q wv. - �I -r���S 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 /> • <br /> Signed <br /> MARCIi\L SCJ(lL�.� <br /> No[an�Publicc <br /> - Commom%ealth of Massachusetts otary ub ic <br /> My Commission Expires <br /> SEAL - March',I.1006 3� <br /> Commission Expires: <br />