Laserfiche WebLink
63P <br /> BUSINESS CERTIFICATE#W <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE r / �7�"� • <br /> Expiration Date: December 31, -204 <br /> �f'2 <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 J �J <br /> S/l� 1b �N t2�1g2t Q P DBA j—�� LIVII ,7/ is conducted at <br /> Business Location: 3,9> /1o,'t. %jbQpS <br /> Business Mailing Address: �-'Z P/11�/ti�11�/ �� /Z3x E� /y/9 <br /> 8 3 <br /> Business Type: Business Telephone: ��i /-/-77x23(9 <br /> by the following named persons: <br /> FULL NAME RESIDENC, <br /> i <br /> QLy; /Y)A cg 33� <br /> Home Phone: 835' Z66 <br /> I certifv under the penalties o perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> tes lied under law <br /> i tore of aurhorizea a ent _ "Signature of authorized agent - • <br /> "Social SectuityNumber(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: o3V 7� � <br /> Alarm Company: &A& 6/7 69n a 3WceJO <br /> *This license will not be issued rmtess 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 incorrect 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 ojMassaehusetts <br /> BARNSTABLE ss DATE <br /> Personally appeared before me the above-named and made oath that the foregoing statement is <br /> nue. <br /> A certificate issued in accordjynce 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 thereafter so long as business shall be conducted and shall lapse and be void unless so ewed. <br /> Signed �� �4 . ( <br /> �1 <br /> • Notary Public • <br /> SEAL <br /> JOSEPH L. <br /> cW 0NWEALTH�OF MASSACH <br /> kN Contrissm EOM <br /> Oclttier 1019 :j <br /> I <br /> J <br />