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2010
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Last modified
11/17/2016 3:11:02 PM
Creation date
11/13/2016 10:16:34 PM
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Box 038
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BUSINESS CER'T'IFICATE# R0,(Q <br /> TILE CODItYIONIVEAI_TK OF NIASSACIIUSETTS P <br /> TOVN OF AIASIIPEE <br /> DATE I I <br /> Expiration Date: T1—!� <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 /> Business Name/D A;,&ri:a C ( I,a� Corporation Name: is conducted at <br /> O \-Ite�3)eun'th' S��c-T(1 �lis <br /> Business Location: <br /> Business \flailing Address: ()u <br /> C <br /> Business Type` f'-(' C- ffiI'11 Ylt'A _.YV�ppII-usiness Telephone: 7�y I (200Home Phone: L4 I G- AL/ is `'1 Email Address: l l V,` 2 u GC G j( 6Z< Q l f0'1lt <br /> by the following named persons: <br /> Owner N. ae Ot'ter Residence p <br /> ��nirle � Pp ��l L <br /> c <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 required under w. - <br /> P/I <br /> of authorized agent "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> (( �,, 'O In case of emergency <br /> NANIEi�j( y le 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 suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth ofAlnssachusetts -7' <br /> v <br /> RML\STtU3LE ss ('�If_ /� DATE �-d <br /> Personally appeared before me the above-named J/+t L✓v u :D/r- 1644L 0 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 be renewed <br /> each four years thereafter so long assuchbusiness shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> Notary Public <br /> • SEAL gSASMI.MAM W. <br /> w� ' � <br />
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