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BUSINESS CERTIFICATE#05 SS/ <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 pTI <br /> DBA 1�C{�,J Ldi'IL.� 1� is conducted at <br /> Business Location: Y'(�-C.r�7lVIL-,pC. e ,),-) <br /> Business Mailing Address: �'�t�h-- 4,—k <br /> Business Type: emii , 164j L Business Telephone: 5Z-zi <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone: D -�>q <br /> es, <br /> under the pe erjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> es as re ire der <br /> *Signature of authorized agent *Signature of authorized agent <br /> 0-57- - (44(.q9 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 Cmumonwealth of Massachusetts _ <br /> BARNSTABLE ss DATE I SaOdS <br /> Personally appeared before me the above-named �/ Nl"l�S D �Q t'`Y /� 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 /> �ed <br /> TI:�Itl'I'A 1 SCOT <br /> Notan Public otary/Public <br /> SEAL Commom,ealth of Massachusetts <br /> My Commission Expires I/�h .� aQQ(p <br /> %larch 31.2006 --. <br /> Commission Expires: <br />