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cl <br /> - BUSIDIESS CERTIFICATE#06-& <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE DATE /o/6106 <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 ddeeccl1arree(ss)�thhat a business under the title of <br /> J D1 ' 1 F'I`'�", 1�.en/ �I rt(Ci g� DBA (b0j J I jyCI� is conducted at <br /> Business Location: JD(o FQlmvA IL m V f- f <br /> Business Mailing Address:_ttittT�f _I(SOLOWL J / J <br /> Business Type: I A r T7Business Telephone: 7—pJ'✓ <br /> by the foolllo�winsg named persons: <br /> / <br /> JL NFs r �� <br /> Home Phone: <br /> I certify e e pena ies of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> jesRre ed and law. <br /> authorized agent *Signature of authorized agent <br /> - 7) 3 <br /> ocial Security Number(Voluntary) <br /> or Federal Identification Number <br /> jam <br /> In case of emergency <br /> NAME: r :�4 TELEPHONE NUMBER:.7��[drl/ ✓�'� <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 Q h <br /> BARNSTABLE ss DATE LJ <br /> Personally appeared before me the above-named W t IC,J 1 1 1 O 5w and made oath that the foregoing statement is <br /> true. <br /> A certificate-issued in accordanc 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 s .long as sue usiness shallbe conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> �- <br /> • - Deborah F. Dami Notary Ppbl <br /> SEAL. <br /> NOTARY PUBLIC <br /> Commonwealth of Massachusetts Commission Expires: <br /> My Commission Expires July 24,2009 <br />