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BUSINESS CERTIFICATE#07L3 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE y <br /> DATE <br /> Expiration Date: December 31, 2011 <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 /> I/J W CA) N- E C Of 1 DBA is conducted at <br /> Business Location: -e {' r G (�Gd l q1 C) dr �o S (1 P-Q P M14 (vet (o `f <br /> c <br /> Business Mailing Address: QL /a t-AQZ <br /> Business Type: 12 Q.(2l t 4 i o-k Business Telephone: S O 5 a,i 3t 55 <br /> by the following named persons: _ <br /> FULL NAME RESIDENCE <br /> 40 � �; asary X230 htee ; �� 4l.tou � <br /> Home Phone: <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 /> l (•GL�t/� Z/I�t �'t9'C'l <br /> *Signature of authorized agent *Signature of authorized agent <br /> 033 60 f`� <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 O <br /> Personally appeared before me the above-named H'h I'-fl tID r=- 15L/Ara gad 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 /> �ed <br /> SEAL otary is <br /> COMMONWEALTH MASSACHUSETTS <br />