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BUSINESS CERTIFICATE#06 -� <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2010 <br /> In conformity with the provisions of Chapter one"hundred and ten, Section five of the General Laws, as amended, the <br /> igtdersigned hereby declare(s)that a business under the title of <br /> DBA f15� is conducted at <br /> Business Location: �c 1C� �f2 <br /> Business Mailing Address: �>a -A-, <br /> Business Type: C a 5L) �ivl. Business Telephone: <br /> by the following named persons: _ �a Ll <br /> FULL NAME RESDENCE <br /> G <br /> Home Phone: <br /> Alftrtify 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 on ®r law. <br /> *Sign a of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number ' <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <br /> *This license will not be issued unless this certification is signed by applicant <br /> **Your social security number will be fumished 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 sustiension 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 /pJ DATE 3 Vj, ,k Zp 2�[p <br /> Personally appeared before me the above-named D�7�e. �n 1lV and made oath that the foregoing statement is <br /> true. v' . <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 Qt reafter so long as such business shall be conducted and shall lapse and be void unless,so renewed. <br /> �d �. <br /> DeboMhF _ • ' - _Notary Pu 1' <br /> SEAL NOTARY PUBLIC <br /> f"AlIM11011NIdN of�. �"' <br /> Wt,*'H,�^t :,,-, . "� "�0VYCWdrft0E <br /> °° Commission Expires: <br />