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BUSINESS CERTIFICATE#ZW (� <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OFM,4SHPEE Q <br /> DATE <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 /> YJ �55A / �[DBA &', �/ X��t DZ/1 50 1 is conducted at <br /> Business Locat H6 ` /� �`I 1 Olei.R aak <br /> Business Mailing Address: Pc:7 Rd X 1, �-Y�yrp�J 1 � BQ /3-�b <br /> Business Type: I i l 0� '(� ( Business Telephone: <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> WQ't�� qcJ- Q <br /> Home Phone:�- V leo <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 /> • re fired under law. <br /> ,je <br /> te of authorized agent •Signature of authorized agent <br /> -- ��6 � �a� <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> � pp \ In case of emergency jf� Iy�9 <br /> NAME: �(�qM. �l/ t TELEPHONE NUMBER:J�`'Y -9 10- <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 thew non-filing or delinquency will be subject to license suspension or revocation. This <br /> request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth ofMassachuseth p-� <br /> BARNSTABLE ss y� DATE <br /> Personally appeared before me the above-named 2- 2c t't , 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 ears thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed ��`C ��C�,�� <br /> KVW Pudic <br /> • ota, TM <br /> SEAL OF M <br /> otarytBlnIDaaniulon EVft <br /> Commission Expires: <br />