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BUSINESS CERTIFICATE#05 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE .Z I S CJS <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 /> `Juuuwt l �r4fupYa� l DBA is conducted at <br /> i <br /> Business Location: 6 `A <br /> 9 <br /> Business Mailing Address: :5AU '5 q <br /> Business Type: f{�rncoyl,Ul,'u�! ���-IrG� Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE e <br /> P y� 5yx' l f7 Y rJAIy <br /> 0Aq-5-NP4-4- 6z6�t� <br /> Home Phone: ",f6-477" <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 /> s as require nd law. <br /> *Siture of ind' idual By: Corporate.Officer <br /> Z — <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 request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE eb 16 COQ`! <br /> Personally appeared before me the below named � 2.� Y� t y hart 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 Ion as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Si <br /> 1-2 <br /> aryP is <br /> SEAL <br /> G ✓cJ 3(, ,2660 <br /> CommissionExpires: <br />