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r <br /> BUSINESS CERTIFICATE#06 --36 <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE q 1 1 D /Q(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 11� <br /> (��_ DBA CO�t S � T� 1e is conducted at <br /> Business Location: ' `+ b0'yA01n Al <br /> Business Mailing Address: Po cO )g�q�s ,p s vt •`�tV t,/I �t� t(Dot <br /> 61L <br /> Business Type: n i c Business Telephone: 6 D -!_3 7o? <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> SA/>,eS 1� VAC(6 � hi4 �n ritq<S/�h3 Yt7IIS /rl4y,Zd��' <br /> Home Phone: <br /> 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 /> xes as required under law. <br /> .6fx✓ - <br /> * ignature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number ' <br /> In case of emergency <br /> NAME: 7!�-Le_ CArVA IKv TELEPHONE NUMBER: <br /> -Alarm Company: I�� <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 /> . <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> "BARNSTABLE ss - DATE fl—lCD aoa b <br /> Personally appeared before me the above-named — k rr e g C" U 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 /> argaret C. Santos <br /> f�4'$( NOTARY PUBLIC ll Lary Public <br /> SEAL Commonwealth of Massachusetts <br /> HY Commission Expires Sept.24,2010 <br /> Commission Expires: <br />