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BUSINESS CERTIFICATE#68 L( <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE ji <br /> DATE .��JI0c:,'n {� <br /> Expiration Date: December 31, 2012 <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 /> � dYYNfY�/�t/1 &, tl JJ-6, DBA / is conducted at <br /> Business Location: /q 4"xkrJ ,504-G i/ 41�u�[��L [ Ut`N M'✓Iff✓1 S <br /> Business Mailing Address: AW q�T/3 ,�,e � �Jtn✓l�s W0J 04�b e) <br /> Business Type: Business Telephone: 639-.�6-C)O <br /> by the following named persons: <br /> FLL NAME RESIDENCE '1 <br /> cStrtwin n.t iDla R� �3 �1 Soy �cn 1STf�Rq��Ho <br /> Home Phone: <br /> Oertify under the penalti f perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state - <br /> es as re <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 of tax <br /> payment obligations. Licensees who fail to conect 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 U <br /> Personally appeared before me the above-named S 144 k_).% "y yi+J)_h and made oath that the forgoing statement is <br /> true. <br /> A ceitifcate isss d Ln ace id ice 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 there #tie( ch business shall be conducted and shall lapse and be void unless so renewed. <br /> �ned <br /> " JO PHJot�!! <br /> SEAL - Notary Public <br /> COMMONWEALTH OF MASSACHUSE718 <br /> i <br /> , fin .fines: <br />