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BUSINESS CERTIFICATE#05 -10-? <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE G�3o-aao� <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 /> f C �`i_'S�l 11 DBA is conducted at <br /> Business Location: <br /> Business Mailing Address.:G, <br /> Business Type: f�k fig Business Telephone: ZOZ• 6"�q7e3?- <br /> by the following named persons: <br /> E ��77 <br /> ffi�i� � f3 (.'�/ 'IZESID ,c 6t <br /> Home Phone: A')e• <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 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 fumished 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 -3U-G <br /> Personally appeared before me the above-named {q l h sue) �B f PSS i 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 ears thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> NOTARY PUBLIC <br /> 1 Commonwealth of Massachtlu to Nota I ubtie <br /> SIAL Ny Commission Expites Sept.24,2010 <br /> q-ay Bio <br /> Commission Expires: <br />