Laserfiche WebLink
ti 63 <br /> F' BUSINESS CERTIFICATE# 10- <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: December 31, 2014 <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 W,�og pQ�eCOWA7%-y <br /> Pb—1E7i2-f'K+ /12a/Ar f?AJ 2E y DBA%ffE,k(E�<r6E,&C_7 0� is conducted at <br /> Business Location: IZO NL45ffP E 11411- Cbl( 49 <br /> Business Mailing Address: (( WIL.A t A/ IM. /fP f /Nff' C6264t9 <br /> Business Type:J ){JOIj!) FLCOZ COI PAIV y Business Telephone: <br /> Home Phone: T74 a39-0'74 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> 126-rz-� W/4_+ArAf 2n. /titAs�Pr_�, MIt- --) i <br /> Kk77i4&-ZAZ T &?t& :;y 1I t' 14,4ALAT rzD zip_ iz <br /> 1 certifyunder the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> red <br /> �./// C under <br /> o.�:ZZ , <br /> *Signature of authorized agent *Signature of authori fd agent <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 mel 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 p A/ DATE .Z. <br /> Personally appeared before me the above-named I QTwr w and made oath that the foregoing statement is <br /> true. �y <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 fours ere er s�as sue usi ess shall be conducted and shall lapse and be void unless so __ wed. <br /> gned. L 1 <br /> L. Notary Public <br /> SEANctaryke <br /> COMMONWEALTH OF <br /> My Cammise+on Evian Commission Expires: <br /> 25.=13 <br />