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BUSINESS CERTIFICATE#06 -66 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE (/ / c;7606 <br /> Expiration Date: DQCCIYIher 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 declare(s)that a business under the title of / � <br /> ArA162"..✓ LN'Z.2iQ/SFS. In/c DBA d,1�. L7DDD/J2.io LD,t,/p��/y is conducted at <br /> Business Location: /GG �AL.t/OUTN iQoA �AS.0 OFer A�.9,/D�b sL 4 <br /> Business Mailing Address: <br /> Business Type:&ULZX4 r 11rr &L A.•B n/ /- Business Telephone: 7S ,?-675 _7745 <br /> //FNliNG .fO NBL/63 <br /> by the following named persons: <br /> /+ FULL NAME � RESIDENCE,r� <br /> f�.¢6vSa✓ CNT AA41.'[rs �il/G /alSuu ✓47F.rRSon/.�Y6/l'G*WPa�ri(/<crs (�/� ddLO� <br /> Home Phone: <br /> I certify under a penalties of perjury that I,to the best of my knowledge and belief,have filed all state tax returns and paid all state <br /> •taxes as q ' e under law. <br /> r <br /> *Signature o aut ori ed age ,Zy f/riLL r *Signature of authorized agent <br /> /.t/i 77/ <br /> **98841 8080F45,NufabeF(Volo"tary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> *This license will not be issued unless this certification is signed by applicant <br /> **Your social security number will be famished 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 <br /> request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> G/ -/ DG �WAoerulws The Commonwealth ofd ✓r 2E,a//y <br /> �BbFrss DATE &r. o1_ooG <br /> [rue. Personally appeared before me the above-named fav L104 I//C'Ae dee/ and made oath that the foregoing statement is <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 /> RY <br /> 1 t�G�Notary c.� C. <br /> • G�� GARY Public <br /> EAL <br /> a _A'we 30 —90/e <br /> Z Commission Expires: <br /> PU�L1�o�S <br /> �NWEAItN <br />