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BUSINESS CERTIFICATE#05A3 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE " 20 Uos� <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 abusiness under the title of <br /> /'oq i ✓r( r✓Z DBA / / /4 is conducted at <br /> Business Location: J {7 Y Q' (/I/. / ' of�t l� - /"t e/- b / y <br /> Business Mailing Address: c/n /q QP�Y <br /> Business Type: i6 r'I/6' Business Telephone: � O $_( / <br /> r <br /> by the following named persons: <br /> RD <br /> / � LL NAME <br /> C)m S FuWgVIre. CIPMPrvr /4ENAgA/J-e-e- 1-4,q. 62e 9 <br /> Home Phone: <br /> 10�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 /> es as required under law. <br /> *Signature of authorized agent *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 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 . <br /> BARNSTABLE ss DATE G G Sl <br /> Personally appeared before me the above-named i r,/1M <br /> &VVt 4 S l h men {-S and made oath that the fof"egoing 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 thereeaa car so long <br /> as such busure shall be conducted and shall lapse and be void unless so renewed. <br /> Signed /�/�1 <br /> & MafgaretC. .Santos <br /> Notary Py he <br /> SEAL NOTARY PUBLIC <br /> CommawieftofMa Nchumn <br /> UpConimisif'61gte8.SW.24,2010 Commission Expires: <br />