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I ' - <br /> BUSINESS CERTIFICATE#05 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <::%,L, 13 X00 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 abusiness under the title of <br /> ` <br /> 1, )4— DBA I is <br /> conducted at <br /> Business Location: �� rl5 { � �s nc� e�����ptTl�eSS 1 mG�C Pk��tCP IYP.w ]aabyi <br /> Business Mailing Address: 33 Cott'e4( , ACS S 0(s l t m\�1Yan 1`(Np. Oz3�Z <br /> Business Type: Business Telephone: '1!?)} <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Lni\ r 33 CczPn t�c�cc5 CJS <br /> Home Phone: _7Zt <br /> W_ <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 /> OLD -Lot- 5YFS2 <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 suspensionor 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 DA <br /> TE aCfr <br /> Personally appeared before me the above-named 1.5�\ \ yy\t..h01's -�Fn f rand made oath that the foregoing statement is <br /> Ime. <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 /> M8fg8f81 Ci. .Safl� <br /> ¢� s. <br /> NOTARY PUBLIC Comon aft Of Mau 0 N6tcry Public <br /> SEAL *o=ff" 0 SW <br /> g-ay-'�)$o <br /> Commission Expires: <br />