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a BUSINESS CERTIFICATE#06.3 Z. <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 3I, 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���O ��L� \1 � ���� is conducted at <br /> Business Location: <br /> Business Mailing Address: <br /> Business Type �tln^ Business Telephone:"'�'b <br /> by the following named persons: \ <br /> FULL NAME SIDEN E <br /> Home Phone: 19o\ �—�J�Z <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 /> es as required under law. <br /> W Nzs� _ <br /> *Signature of authorized agent *Signature of authorized agent <br /> y� o L�� <br /> **Social Security Number(Voluntary) <br /> or Federal IdentifA tc_ ati n Number <br /> In case of emergency \ <br /> NAME z'C�2�CA\c�\� 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 request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss DATE f �A Zo <br /> Personally appeared before me the above-named /�/S(L � � 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 lolig as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> - Notary Pub is <br /> • <br /> SEAL 4, Deborah F. Dani <br /> NOTARY PUSUC <br /> �. cmil 01nleft of Commission Expires: <br /> My CommhWon Wm July 21,2009 <br />