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Dom. .. <br /> BUSINESS CERTIFICATE#05 -33 <br /> .� THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> „amu Exp ration 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 <br /> l declare1(s-)that a business under the title of r. 1, - - ,', <br /> FL hwo� 1 AD 1_Itrd b5060JC'A .t-r�c.DBA �Sr 1 1�2G t � V� �/ ✓ is conducted at <br /> Business Location: � �Qsty1a .I �Dv 'k /Z'_ sk e,&� � FAY Op (,S�q <br /> Business Mailing Address:, I�' ' (� <br /> Business Type:^ �(,�yy 1 l W Business Telephone: -154-6 - S _,- 00 <br /> by the following name.persons: <br /> FULL NAME RESIDENCE <br /> Home Phone: <br /> � <br /> ertify 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 /> xes as required under law. <br /> *Signature of individual By: Corporate Officer <br /> - 9 a 0'Dd <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 determinewhetheryou 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 II <br /> BARNSTABLE ss 1 I ` DATE �o 1aO <br /> l0`{ <br /> Personally appeared before me the below named 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 /> /elf JACALYR JEPSEN <br /> MY CONMMiSrSMIEeXPIRES <br /> SEAL OCTOBER 30,2009 <br /> Commission Expires: <br />