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BUSINESS CERTIFICATE#05 -57 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE rn n/ 3r7 �5 <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 h reby declare(s) that a business under the title of <br /> M�6 I.- — rUn� A DBA/ s conducted at <br /> Business Location: AA/ "�,t <br /> Business Mailing Address: /�/� �Q� jy � _ •/1 /7 Y� /4� <br /> Business Type: �r� Business Telephone: <br /> r <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> -- #AW Z. WAI <br /> Home Phone: _!6g- —!qg /� <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 required under law. <br /> *Signature of individua By: Corporate Officer <br /> 095 Q73 7/4 <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 Massachusens General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss i ( DATE as <br /> Personally appeared before me the below named �}rKt,�( I-�-p.4-t(6 Z rn S 4 Yt 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 /> id, CZA <br /> OS <br /> • ° NOTARY PUBLIC <br /> Commonwealth of es Sept 24 2010 Notary Public <br /> SEAL yly Commission Exp <br /> ay C9J o <br /> Commission Expires: <br />