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' r <br /> BUSINESS CERTIFICATE#05—10 y <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE .l V A' <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,bfjeby declares)that a business under the title of <br /> y�y��1fO A/ DBA !3' M Ol 6 conducted at <br /> Business L cation: // A 415 ti B140 <br /> SS <br /> Business Mailing Address: AoA�a <br /> Business Type: �A•11 /, l �( OGj e/�s's�'felephone: <br /> by the following named persons::FULL / n <br /> �/� I • � V�f6 �� �./lrsea <br /> Home Phone: / / 0 41 b <br /> cxertify under the penalties of perj I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> aes <br /> as require der law. <br /> V� 1 <br /> *Signature o uthorized agent *Signature of authorized agent <br /> o �q -3 zc3� ' I <br /> **Social Security Number(V untary) <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 j� DATE 7-6 - 0�O0� <br /> Personally appeared before me the above-named IN/��. /� O 5S Y/( (J y G son 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 o g as such b mess s 11 be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> l S <br /> otary Public <br /> SEAL <br /> TCommission Expires: <br />