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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 /> undersigned hereby <br /> /�decl/are(s)/that a��business under the title of /] �t / /� <br /> r�( LflG1t, /�.G,>://y/f DBAJ6ka l 6L( �J/,�Q/�lt is conducted at <br /> Business Location: 7Y(7�,,{//LIZ//�/A /��(.l /"( Q f���(�r A%'/ nd�� <br /> Business Mailing Address: �hl�e� (J I 1`4f4"aee' <br /> Business Type: O &A d 1 Business Telephone: <br /> by the following named persons: <br /> Ula F LCQ l I]I `t� 9Gt S� ►�QI�A, <br /> JV <br /> Home Phone: <br /> i <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 t <br /> s required der law. <br /> *Signature of a#furizeWent *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 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 ) <br /> Personally appeared before me the above-named 1P4 V(` 11 f c 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 th eaI ter so long a such business shall be conducted and shall lapse and be void unless so.renewed. <br /> f(j Deborah F. Dami <br /> NOTARY PUBLIC Nota c <br /> SEAL. "��� Commonwealth of Massachusetts <br /> My Commission Etores Jury 24,2009 <br /> Commission Expires: <br />