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� r <br /> BUSINESS CERTIFICATE#0579 <br /> k <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE 1�C 200 S� <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 c('srr- 0 6y<i!( cyto¢ t(S DBA is conducted at <br /> Business Location: Zrl <br /> Business Mailing Address:09' t'Rfayyla_ 1CG• <br /> �{{ppas t <br /> Business Type: [/yk _hf —e-a It r Business Telephone:.rak-r3 9 -L&-J w Tod=S9T• 1?G�/ <br /> by the following named persons: <br /> / Y� FULL NAME RESIDENCE <br /> Chit/ ✓c� lf�i LLr T wt �c3vt S'coLs . 9 9( f a lw-ccutfk `+ALV• 4/431r e7ir <br /> Home Phone:Sy-S34-J-rc3 t {i8 S3Y 17oi/ <br /> 0rtify 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 /> es 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 DATE 19 rt 249 <br /> Personally appeared before me the above-named Et }-1 n i ij I,O �0. t Gc M and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this section sball 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. Dami <br /> NOTARY PUBUC Notary bl' <br /> SEAL <br /> �V�Y�� Commonwealth of massachusett <br /> My Commisslm Egires July 24.2009 <br /> .. .. - <br /> f Comirission Expires: <br /> r, - <br />