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w BUSINESS CERTIFICATE#MIL <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE 1 <br /> DATE O� <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 /> v NTi � DBA C C 1—�f"VOT a� is conducted at <br /> Business Location: <br /> Business Mailing Address:_1 0 f�A�C"O t \-es'S�P lcc V'Y\tk- Octz l q <br /> Business Type: f)t � lar% .Vy Business TelephoneC5"�� <br /> �— <br /> bythefollowing named persons: / <br /> �tJ(& F!t cI �—y I lYj VL RE 510 R\ ,SE <br /> (3p <br /> Home PhonCEP La <br /> I certify under the penalties of pgtjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> xes qu ed u <br /> *Si atu of allthrizcd age t *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAMETELEPHONE NUMBE 2— d S <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 O w <br /> Personally appeared before me the above-namedC30 1 t C(-,S-e—V-- 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 /> _ `\\\\11111111//ltd' <br /> SigtSeT <br /> d-- j�,.��. �,.i h'O <br /> oro '�. � -���e"J <br /> r <br /> 2��P°Par 1a, 9Cn <br /> 4"0• <br /> SEAL Notary Public= �: = r�— <br /> vlt oCommission Expires: <br /> O f <br />