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BUSINESS CERTIFICATE#05� V <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 164 etc � 9 <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 /> go qC (+ CC)o J's DBA is conducted at <br /> Business Location: VX <br /> � <br /> Business Mailing Address: (et W U0 e�- .0 ✓(� �— VXyo" tt �> ✓l�� <br /> Business Type: {ti{t��t(e 1/�401 Le-ty&Cf F-e Business Telephone: �6 g .5,3 /p,`('7 <br /> by the following named persons: <br /> FUL NAME RESIDENCE/ <br /> ��Xs o (� (B 1 (4_)C) ( (4 r!Cft� A-(-2–_ q <br /> Home Phone: O <br /> ify 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 /> 'as required under law. <br /> *Signature of individual By: Corporate Officer <br /> i)- `( -3--)- -Y37� <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 14a kL� <br /> I <br /> Personally appeared before me the below named I On and made oath that the foregoing statement is <br /> true. i <br /> A certificate issued in accordance with this section shall be in force and r et 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 /> 1 --- Notary Public <br /> SCO( <br /> SEAL MAKII A L. t <br /> Notap'Phblic M�r�/_ 31 abd <br /> Common%Ncalth of Massachusetts I 7� <br /> My Commission Expires Commission Expires: <br /> March 31.2006 <br /> E <br />