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}. 1 <br /> dim � <br /> BUSINESS CERTIFICATE# ©(O-C;L <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE DCkZ)bP-K ';)00b <br /> Expiration Date: December'31,i,PC40 , <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 /> S u JS'j'\� J�/ la 11nG �C DBA SUSS nIAL T �//✓ s conducted at <br /> Business Location: ySj GILA3 <br /> Business Mailing Address: &jnjnW cou S NkEL, <br /> Business Type:_ Stl1St.._ y.1 __,_ - Business Telephone__ �iO3�________ <br /> by the following named persons: <br /> FPLL NAME RESI ENCE <br /> CCTL t SMA da635 <br /> Home Phone: <br /> 'I certify under the penalties of perjury [hat 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> axes arequired unde aw <br /> *Sign4Sur authorized agent *Signature of authorized agent <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 socia! 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 ,, a <br /> BARNSTABLE ss DATE O�ybett t{ aoa 6 <br /> n. II , <br /> Personally appeared before me the above-named 7A Ml' °e a l li-S 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 yea thereafter so n s such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed C� r <br /> Q _Margaret C. Santos tary Public <br /> SEAL NOTARY PUBLIC nn _ <br /> Commonwealth of Massachusetts 7 —)-(190�a <br /> My Commission Expires Sept.24,2010 Commission Expires: <br />