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77 <br /> ' BUSINESS CERTIFICATE#09 r63 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: Deeember 31, 2013 <br /> In conformity with the provisions of Chapter one hundred and ten, .Section five of the General Laws, as amended, the <br /> tLthat a busgiess under the title of -. - - - <br /> undersigned l reby declare r ' I/1 ,/� /� �B y� ��//� �,p,�, <br /> tit a DBA 00(I1 \ V�t�tke'o is conducted at <br /> Business Locahon: J <br /> Business Mailing Address: —/7 G _ <br /> Business Type: �a Business.Telephoneq ©0 / / — 'O ! <br /> by the following named persons: <br /> FULL N RESIDENCE <br /> Home Phone: _so0­ <br /> I certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returnsandpaid all state <br /> ^ taxes a5 requiredqunnder law. <br /> rgnature of authorized agent *Signature of authorized agent <br /> o 1-7 H i-1- L4 S acs <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency - - ••-- •• � <br /> NAME: TELEPHONE NUMBER: <br /> Alai in 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 �-�ovZ00 Ff <br /> Personally appeared before me the above-named O d,�Gq Q. A p49 LiI A-ff--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 yearst���hheerreeaftei so long as such business shalibe conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> SEAL CA JOSEPH L fqELLI,JR <br /> o Notary Dublic <br /> �Yv�o�IM C5 <br /> moeetaa,aota <br />