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it <br /> BUSINESS CERTIFICATE#05 '4 S <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE G�_.A q ' a-cab.t <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 /> �— <br /> _(���t+"/t1 DBA 9 is conducted at <br /> Business Location: LJ l Ct m ('t ,�/�I t l OCA PM ce— I r I f) C) <br /> Business Mailing Address: SA Mr✓ -i— C� <br /> Business Type: COC��'i�t`Gr 5 f%5p- Business Telephone: �QT 534 3 O I <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Shell� oCu <br /> Home Phone: 5(79—�J 39'JJ�� <br /> � <br /> rtify 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 authbrized 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 famished 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 ojMassachusetts <br /> BARNSTABLE ss 11 t�,, DATE O a aCAS <br /> Personally appeared before me the above-named � �¢ r �Ut1E'�•\�e tom- 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 <br /> ybu/sinessssQshall <br /> �be conducted and shall lapse and be void unless so renewed. <br /> Signed `� / e444Q4 eX�r'�'"'-CJ •. -` , <br /> OW <br /> Mar9a�et_�.'"Oun_ = Notary Public <br /> SEAL NOTARY-PUSUCCommon th of MassxhusM <br /> Wmft5i011 E)Wn SM.24.2MO Commission Expires: <br />