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BUSINESS CERTIFICATE#06_S.W <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE a/�.�/Ob <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 declare(s)that a business under the title of <br /> DBA Ort' t s is conducted at <br /> Business Location: � T CQH"(I�CG� �9i ' #l0.l" ina sti pee., MA i9 a(o 9�r( <br /> Business Mailing Address: 7 e ocpOeQ� Ct n4& beiV& AUILI'V(1- N y IOU A11tn--7Z K De�d- <br /> Business Type: lt+L' ;l uskytebn Business Telephone: 63(/ 7( 7'6 3X), <br /> by the following persons: <br /> ,FjJLL NAMF, RESIDENCE <br /> Home Phone: <br /> I certify under the penalties of perjuryhat I, the be of my knowledge and belief,have filed all state tax returns and paid all state <br /> • taxes as e� ired u der law. Lisa�appef <br /> 4 e Assistant Secretary <br /> *Signature ofadtMiii6d agent *Signature of authorized agent <br /> /1- 359g7a7 <br /> **Social Security Number(Voluntary) <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 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 <br /> request 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 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 /> Signed <br /> • Notary Public <br /> SEAL <br /> Commission Expires: <br />