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BUSLNESS CERTIFICATE#07 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE _ <br /> DATE ,/ wl✓G3� ;?000 <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 /> /Ver, bl/d/0064"d �DRnI� ✓nlY DBP. _ Mllvivblyd 6o�7ej^4 C/✓/, <br /> C/U�lC' is conducted at <br /> Business Location: /�Q /✓r !/ ,r✓LrCnol 0r!✓L <br /> Business Mailing Address: / f}1 rA4ZZ /mA <br /> Business Type: .lTo�f�(�th/S V��S�b✓rc+iAusiness Telephone: 157)tj — SSI —S SO V <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone: <br /> I cernty 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 /> taxes as required under law. <br /> , YcQ, <br /> ignaru e of authorized agent *Signature of authorized agent <br /> ab - I (oLfcK <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 tiling or tax <br /> payment obligations. Licensees who fail to correct their non-filing or delinquency will be subiect to license suspension or revocation. This request <br /> is made under the authority of;Massachusetts General Law, Chapter 62C. Section 49A. <br /> The Commonwealth ofNlassachuserts <br /> BAR:NSTABLE ss DATE 0.Y1 ars vS <br /> Personally appeared before me the above-named Q I cn�Q Le (2 kulr 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 fouryears thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> lea <br /> N� r(�CB o 1 2 ,, , (➢rn <br /> • - Notary Public <br /> SEAL <br /> Commiss on Expires: <br /> MICHAELLE MEN A$ <br /> ,e NotaryPubllc <br /> {} Com y comm a Maes vI <br /> My Comm�lon Expl/®6 <br /> dufy26,2412 <br />