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f <br /> BUSINESS CERTIFICATE#05.:1_Wg <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE ' <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 /> oT DBA L © is conducted at <br /> Business Location: /'�7� �� /_ /� (� <br /> Business Mailing Address: D F 11 � 2 ✓D �S- �.2_ 1 YL � 40,;'41/7 <br /> Business Type: Business Telephone: Y / / <br /> by the following named persons: <br /> FULL NAME LX.f�L RESIDEN t- ' 4 , > <br /> 5-c6 <br /> J r 4&-& <br /> Home Phone: Q52 4R7 <br /> Dcertify 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 individual By: Corporate Officer <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 reque=_t <br /> is made unde-the aethcr,} of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts I f <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the below named "?)p �-in re.nt,l_ c.',,,O rl ff'?:r% and made oath[ha a foregoing statement is <br /> I <br /> O <br /> true. J <br /> A certificate issued in accordance with this section shall be in force and effect for four years from the date ofissue 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 /> • No rY blic <br /> seAl Deborah F. Dami <br /> h °� NOTARY PUBLIC Commission Expires: <br /> CWMTO MIQ M Of Mundws h6 <br /> Mr CWffAsial Eli mJId924,2DW <br />