Laserfiche WebLink
BUSINESS CERTIFICATE#01 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE• �( QO DATE \ <br /> Expiration Date:December 31, 3.0$ 76( 3 <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the <br /> undersigned hereby decl�arre(s)that a business under the title of <br /> "[/G4( ',J //k fe-4 C-f DBA rz f0 vA ck ID4- 'C is /conducted at <br /> Business Location: 1 /oU /✓'�-' a/'L- �l�s �1'1i { �'` � �a tO 7 <br /> Business Mailing Address:�(.q <br /> /a <br /> Business Type: !n G G Business Telephone: 660 8 - V7 7- <br /> by the following <br /> named persons: <br /> ' /' / <br /> /r'//L/itG1����Y�f SIDENCL <br /> Home Phone: <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 /> taxes as r ' ed under Is <br /> •* ignature of authorfzed ag6nt *Signature of authorized agent <br /> .26 - Y/s 70G V <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 /> BARNSTABLE ssThe Commonwealth of Massachusetts -- q <br /> � <br /> Personally appeared before me the above-named[W"KA r�_ `CP\NQS 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 he renewed <br /> each four Years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> 2'Ta <br /> SignedVICIQ ANN GOVOM <br /> � xyl✓ Notary Public <br /> COMMONWEALTH OF MASSACHUSETjO <br /> tanY pVfflJ;oum%ssron Expires <br /> SEAL - July 19.7019 <br /> • Commission Expires: <br />