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r <br /> a <br /> BUSINESS CERTIFICATE#07-Q <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE / <br /> DATE <br /> Expiration Date: December 31, 2011 <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 /> TnC� DBA W a e bal e �bi-L 1;)]u�n c,n is conducted at <br /> Business Location: 83 we5� Wer,., oD&L(Cf <br /> Business Mailing Address: �} . O . �Jc�C )grt71, CohJ,� vllt-L W63.5 <br /> Business Type: W�"Y��tKi le_ - Business Telephone: &V 3145'1-/007 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> L+r)13cL ' orP 83 west a5 m () t' <br /> Home Phone: ,5M 477-5r7c/3 <br /> I certify 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 /> s as required under law. <br /> *Signature of authorized agent *Signature of authorized agent <br /> Gil-acro 9c65D <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 subiect to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> BARNSTABLE ss <br /> The Commonwealth of Massachusetts DATE 6 O6 <br /> .�� l <br /> Personally appeared before me the above-named 1�,� r. TU \Ino f n 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 thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Od OC <br /> �( <br /> S . M'roylhe <br /> OIOZ'lppW�dt3 Notary Public <br /> SEAL W p lmaftu m.3 <br /> vend U -\ -;LQ \0 <br /> 773NNOOD"•g 3NNW Commission Expires: <br />