Laserfiche WebLink
a nv l� <br /> BUSINESS CERTIFICATE# <br /> THE COMMONWEALTH OF MASSACHUSETTS n a7✓ <br /> TOWN OF MASHPEE _ C <br /> DATE <br /> . - Expiration Date: I .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 declare(s) that a business under the title of/ J <br /> Business Name/DBA: rl-/-/?"'S5 p �f'✓0//u >/0/1 4Antl/�/4orporation Name: <br /> is conducted at Business Location: /z 6 C'/y t i�A,) 6�d Commercial_Residential� <br /> Business Mailing Address: —7/ 6210AILi JY L✓ 1h// /2c-P 104 !P– (` p <br /> Business Type: T/ Tn PS S Business Telephone: SOP -2 76 <br /> Business Phone Home Phone: Email Address ) e 'W 0mval <br /> by the following named persons: <br /> „owner Name Owner/Residence <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 law. <br /> QdQ <br /> nature 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 /> /l In case of emergency 1 <br /> NAME: ( L(7/�� �/h`GG�fh TELEPHONE NUMBER: <br /> Alarm Company: /U <br /> "Your social security number will be fumished 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 of Massachusetts <br /> BARNSTABLE ss q MM DATE � ~Z <br /> Personally appeared before me the above-named �/ 7/'/e /2,' e"!'!//2, 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 as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> '✓ t2� <br /> Notary Public <br /> • SEAL <br /> D@bp/8fl Daynf Commission Expires: <br /> NOTARY PUBLIC <br /> Commonwealth of MaaMC 29.2016!S <br /> My Commission Expires JUlY <br />