Laserfiche WebLink
BUSINESS CERTIFICATE Q I� <br /> THE COMMONWEALTH OF MASSACHUSETTS P <br /> • TOWN OF MASHPEE <br /> DATE <br /> Expiration Date: 3 3 /2-017 <br /> 9' In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, <br /> the undersigned hereby declare(s)that a business under the title of / <br /> Business'Name/DBA: stocj/a O? Corporation Name: X///- is conducted at <br /> Business Location: <<Street_»«Street_Name» :�Zf ZVJ Commercial <br /> Residential tl <br /> Business Mailing Address: «Mailing_Address>> <br /> Business Type: k Business Telephone: - <br /> New Renewal I M-Home PhoneUrEmail Address: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> I certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all state tax ired under law. <br /> c <br /> orized agent "Social Securityumber(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NAME: TELEPHONE <br /> 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 <br /> filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or <br /> revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C, Section 49A. <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE ss � DATE A AC/AZ <br /> Personally appeared before me the above-named CRT �\ "/.l��� and made oath that the foregoing <br /> statement is 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 <br /> renewed each s ereafier long as such business shall be conducted and shall lapse and be void unless so r ��� <br /> tgned Notary Public <br /> fission Expires <br /> COMWJQVMTH OF MU <br /> 6fpCormissipnE�uey Seal <br /> .?8:1015 <br /> i <br />