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2007
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Last modified
11/17/2016 3:10:00 PM
Creation date
11/13/2016 10:16:24 PM
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Box 037
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I� <br /> BUSINESS CERTIFICATE#073 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE Z <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 /> DBA t/C,477Q,t/,p t �f SUuR(!�S ��N' is conducted a <br /> Business Location: le AP Z-6 ✓G 6✓u.�N 1-4,11--- y)9,4S✓jL <br /> Business Mailing Address: S Fg„'.z-'_' <br /> Business Type: t,1NSVL17Z- t— Business Telephone: 6-0 �,� �J— �J P,3 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> Home Phone: 6-0 <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 /> ,'Is required under law. <br /> l� /r �/CG/J/?(tq <br /> *Signature of aut onzed agent *Signature of authorized agent <br /> O Z 3 —2--& — 6-S—C'3 <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 ?�' C� <br /> Personally appeared before me the above-named /'Ti7T'�� GU41 0 'Mo�ev and made oath that the foregoing statement is <br /> true. <br /> A cc fica e 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 th e, ter'so idhg as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> SEAL �, JOSEPH L.NPbl'�c ubre EW,JR <br /> otary <br /> CON 92V m°mIs 1AW, <br /> October 25,2013 <br />
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