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BUSINESS CERTIFICATE#05.�4 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE Q <br /> DATE <br /> Expiration Date:December 31, 2009 <br /> In conformity with the provisions of Chapter one hundred and ten, Sectionfive of the General Laws, as amended, the <br /> un igned hereby declare(s)that a business under the title of <br /> 1 <br /> (tCA LI _DBA G � � I�r 01,19 is conducted- at <br /> Business Location: <br /> Business M ' ' ddress: <br /> I i <br /> Business Type: n f ( � Business Telephone: !1 — q7 (1-0L <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone: <br /> ce 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 ai req ' under law. <br /> *Sigiiature of auOrized agent *Signature of authorized agent <br /> 2 -?,� 25-2,L 60 Z, <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 th o of Massachusetts General Law,Chapter 62C,Section 49A. - <br /> e onweaUh of Massachusetts ' <br /> U/✓1� r <br /> � BARNSTABLE ss DATE U5 <br /> Personally appeared before me the above-named <br /> y <br /> true. L —and made oath that the foregoing statement is <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"less so renewed. <br /> Signed <br /> - Notary Pub <br /> SEAL DebaMh.F. Demf <br /> NOTARY PUBLIC <br /> 1 Commonwealth of Mmachusft Commission Expires:0MYCOMMISAME)OMMY24,2009 <br /> _ <br /> 1 <br />