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'S <br /> BUSINESS CERTIFICATE#05 <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 /> DBA is conducted at <br /> _ <br /> Business Location: C L WIG <br /> Business Mailing Address: �— <br /> Business Type: N6I(C/ )4 L 0 0 Business Telephone: <br /> by the following named persons: <br /> U FULL NAME RESIDENCE <br /> ef�S�II- MSA- 0 1Z <br /> Home Phone: <br /> ertify 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 /> xes as/required wider law. <br /> �l� / <br />' *Signature o a onze�ent *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 mel 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 Al—' DS <br /> Personally appeared before me the above-named�) e/� ' Le and made oath that the foregoing statement is <br /> tie. <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 /> • MARIT.A L SCO FT <br /> Notan Public Notary he <br /> SEAL Commomcealtit of Massachusetts. <br /> My Commission Expires 4 .4-c-A 31 hOd,6 <br /> March 31.200( r 6 oC <br /> Commission Expires: <br /> I <br />