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Apr 22 05 09: 57a Mashpee Town Clerk 15081539-2892 p. 3 <br /> 11 y <br /> BUSINESS CERTIFICATE p 05�S y <br /> • THE COMMONWEALTH OF MASSACHUSE7'TS - <br /> TOWN OF MASHPEE <br /> DATE_ . �a5/lam <br /> Expiration Date: December 31, 2009 <br /> In c,nifonnity with the provisions of Cbapter 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 �' r`9 1 <br /> lA1n�&�ria DBA-.1 �(21 1 I ( gV1,1,111ILQldCnOq is conducted at <br /> 7\ Business Location: II �� 'v, ���� <br /> (�(6� RDr�S— aG� Itnrnv 19 do�� C� <br /> Business Mailing Address: <br /> Telephone: <br /> Business Type:��'YA1 Business(7 <br /> by the following named persons: <br /> RESIDENCE <br /> e ;LILL r QI S� ryluu S� Tlexb'jf✓ 1Xa '33Z <br /> Homc Phone: <br /> 4a.es <br /> the p Wnes of perlu that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> and ' ' w. <br /> u Drize agent #Signature of authorized agent <br /> N aha �Ol�b <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Nurnber <br /> *This license will not be issued unless this certification is signed by applicant <br /> "Your social security number will be fumished to the Massachusetts Department of Revenue to determine whether you have mel tax filing or Wx <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license se s sue siou or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Consnronrvealth of Massachusetts DATE <br /> BARNSTABLE ss _ <br /> n .--,�y� � G--9.�e t r and made oath that the foregoing statement is <br /> Personally appeared before me the above-named /—t/e--'� <br /> true. <br /> A certificate issued in accordance with this section shall be in force and effect for four years fivm 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 /> Now),Public <br /> • SEAL �q U .7 6r6117 <br /> �! Cotir�ti4ryipLrfj�'9>0N <br /> Notery Public <br /> � ppp,,y Cammonweatth of Massachusetts <br /> \ i My Commission Expires <br /> March B,2007 <br />