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BUSINESS CERTIFICATE#05 w <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Lbi�s <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 /> DBA is conducted at <br /> Business Location: USDA g 28 tA tAA <br /> Business Mailing Address: \,� MA <br /> Business Type: L, Dovr Shea— Business Telephone: 509- L( 3 <br /> by the following named persons: <br /> FULL NAME RESIDEN E <br /> M•c�..o.E� C- , c��: <br /> Home Phone: —01 '-T Z <br /> .certify under the penalties of petjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> ' s as required under law. <br /> *Stgnature of authorized agent *Signature of authorized agent <br /> Z.a - Z-59 ZS37 <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 ) aS'- <br /> Personally appeared before me the above-named M tC\-\v e\ G' C()S 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 /> • MpRITA L.SCOL T Notary PP tc <br /> SEAL Notary Public � / / <br /> ��omvcalth of ala='°°hnsctts %QYG� <br /> is:ion Gxpues 2/ o2CJd <br /> MY Ma ij�,1.2006 <br /> Commission Expires: <br />