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BUSINESS CERTIFICATE#05 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE �/—y.`L— LSur <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 /> )6/l//V Y OC (/A/4'/D OIUS�/ DBA a OLI679e SSP 7- Dl-f-/! / is conducted at <br /> Business Location: a,�9 ,/ e�/fD/Q�� �/ �c�, �/sD�//rf77eSS ��CeP7/ A7G_, f�laC-� <br /> Business Mailing Address: lye <br /> / <br /> Business Type:/�j/`//Q�!!/'� 94�� Business Telephone: J`-Qd" - 5/77 <br /> by the following named persons: <br /> FULL NAME Q / / ENCE <br /> Qww'l <br /> 4l4K'6'elle e 1714 Z)2— <br /> / <br /> Home Phone: 6D(f- y- _77_ <br /> 0 <br /> ertify under the penalties of perjury that 1,to the best of my knowledge and belief, have filed all state tax retunig hnd paid-all state <br /> es as required under law. N '''n-, <br /> C 7 '. <br /> r- <br /> * gnature of authorized agent *Signature of authorized agent N <br /> N t'� <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'ect 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 nn <br /> BARNSTABLE ss "� DATE ri(> z t�- Zz• LG�S— <br /> Personally appeared before me the above-named'.L'LS h n c, �OC hn no WS Cn 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 foury@�i� 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;uitt� ss o d. <br /> Signed `,a�,••y.NYaiVgO'l7'i <br /> �•$0Q �G N.T <br /> �.� ,• �,ZLtary• ublic <br /> SEAL i 2qU}i pF <br /> Commission Expires: <br />