Laserfiche WebLink
BUSINESS CER'CIFICA'fE# 10 03/6 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWNOFMASHPEE ` I O q <br /> DATE <br /> Expiration Date: December 31, 2*" . <br /> ao� N <br /> In c ormity with the provisions of Chapter one hundre d ten, Section five of the General Laws, as amended, the <br /> undersigned ereby declare(s) that a business under the title of <br /> o C, DBA �1 is conducted at <br /> Business Location: Q Ci S / V ITl 7 <br /> Business Mailing Address: <br /> b�C 6' / ' / l(Ny.�,(V��{ 1 �r at-t-/�Lf�r 7� <br /> Business Type: G j�,�P��`/ Business Telephone:y1 l/ (S"^ Z ( 1 ( 7 <br /> by the following named persons: <br /> NAIi <br /> Lc �ySIDE�� <br /> Home Phone: l/ n V `I ( / ^ / ��U Email Address: o h.IQ1 CDC st <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 /> acs as reeqgtrit rider law. <br /> , <br /> I <br /> !fit Vr' YP��r�P��c3�j�c�rnea <br /> �Stg \ure of authorized agent ema M a dress <br /> �aLl L 0 1 <br /> • ocialSecurityNumber <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <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 susocnsion or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Common wealth of Massachusetts <br /> BARNSTABLE ss ll '/ ' 'V/ DATE <br /> m <br /> Personally appeared before me the above-naed k/L-P 4( AL' N>� and made oath that the f regoing 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 y rs thejepfler so long as such/business shall be conducted and shall lapse and be void unless so renewed. <br /> Signcd Y <br /> • SEAL (1 �, JOSEPH I..MAa1.1100gEW, <br /> Notary PuDfit <br /> omW <br /> xs,2ota <br />