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BUSINESS CERTIFICATE#05_P <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE d r /"3— <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 /> DBA (L�— efdp7 %c/�' /f" is conducted at <br /> Business Location: !;2l 7 / rfd"Yf % Dr rY <br /> Business Mailing Address:�;ki 7 g�� �rr-7;L 7— f°i 7V r_X„Q1( M A£10-x'6� Z-474— <br /> Business <br /> 474—Business T}'pe: Business Telephone: C � G/may <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone: 77 S—yOL <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 /> es as requirr law. <br /> C <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 s-� <br /> BARNSTABLE ss � DATE <br /> Personally appeared before me the above-named` )4L) ✓UW/] and made oatb that the foregoing statement is <br /> true. <br /> i <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 /> ,M 1,A I-.SCOTT <br /> \otcn f Mac /✓ ota blic <br /> SEAL - <br /> Ej <br /> Conihh of Massachusetts. <br /> Coinmiss;on Gspves <br /> March=1.2006 � <br /> Commission Expires: <br />