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r <br /> r BUSINESS CERTIFICATE#05 1 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 3 -1 5 — 0 5 <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 /> V 5�u n 04,c C_ DBA is conducted at <br /> Business Location: u P Pt r l e �. I 0e e r Cr s s <br /> Business Mailing Address: G i Po- I m o u +t') d un (4 — <br /> Business Type: o p -�oyt" e-4—i J+ Business Telephone: <br /> by the following named persons: <br /> FULr rAME RESIDENCE <br /> yY)ne_ C�Yove tJ �_ 115/5p <br /> Home Phone: �- y-2 8" 7��0 <br /> under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns slid paid all state <br /> Serstrequired under law. <br /> *Signa"ra uthorized ent *Signature of authorized agent <br /> aa� 3&,-3L/3.0 <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 7 w^s— <br /> BARNSTABLE ss DATE c—c.Cl <br /> Personally appeared before me the above-named l/I Q �trQ3 Q 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 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 /> • \ ! <br /> Deborah F. Dami <br /> NOTARY PUBLIC <br /> r.. Commcnweallh of Massachusetts <br /> Notary P is <br /> SEAL My Commissitm Exores Jury 24,2W9 <br /> ` Commission Expires: <br /> i <br />