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BUSINESS CERTIFICATE#06_E�, <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE 6/Zy/p6 <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 /> r� S /� DBA ee S is conducted at <br /> Business Location:_ S �CS � /c /ol� /YIaS"�e 7 � �z6y�f <br /> Business Mailing Address: Jq yn,- <br /> Business Type: Business Telephone: 77q- �J C <br /> by the following named persons: <br /> /82 FULL NAME RESIDEN E <br /> AD <br /> Home Phone: <br /> Awertify 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 /> iiiiiiiiiiiiiiiiies required under law. <br /> *Signature of authorized agent *Signature of authorized agent <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <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 J Um e L1 'aop(o <br /> Personally appeared before me the above-named M=Gt�i.e 1 W�`�sa r>, U-t.• Qand made oath that the foregoing statement is <br /> [rue. <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 tour years thereafter so long as such business sha l be conducted and shall lapse and be void unless so renewed. <br /> `+Margaret C. Santos <br /> NOTARY PUBLIC <br /> '—)�=" <br /> Commonweahh etllAL%ld eS81le <br /> SEAL otary Pu <br /> *Commission EONS Sept.24,2010 3D110 <br /> Commission Expires: <br />