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w <br /> •y BUSINESS CERTIFICATE#06=3,2 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE �I f <br /> • DATE_-rh� �(p <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"E"SU <br /> l' 111 b� DBA &b&ti� � _ is conducted at <br /> Business ocation: 15 bn J V i(IA) V W 6Z <br /> Business Mailing Address: I�j -rDYI(� V LuJ J A o ovo'u t KkA ul1 q <br /> Business Type: 2d S1 6+w\ Business Telephone: <br /> by the following named persons: <br /> ULL NAME RESIDENCE <br /> �.4 YVCt.VL�6I 15 �a)ek V i aw D NA as112eyi,4 q <br /> Home Phone: _905"S39 ' 1 �J5 <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 /> *Signator authorized ages *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency 1 �y <br /> NAME:�O TELEPHONE NUMBER: V ' $ I bZ4 <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 t-f <br /> Personally appeared before me the above-named—­lac,r^ei IF m4 L�,o 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 /> • . - Notary Public <br /> SES- Margaret C. Santos <br /> =NOTARY PUBLIC �/ 3Y- 0 <br /> Commonwealth of Massachusetts <br /> 0Commission Expires: <br /> Ny commission Expires Sept.24,2010 <br />