Laserfiche WebLink
BUSINESS CERTIFICATE# Q5--101 <br /> THE COMMONWEALTH OF AL4SSACHUSETTS <br /> T0YYN0FAL4SHPEE . <br /> DATE � '`31oto <br /> Expiration Date: December 31, cPoo� <br /> In conforrnity 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 /> S C S n. 2 :rS Z" DBA S�-k�_ w, < b S P• 2, r s is conducted at <br /> Business Location: \C C� ti <br /> Business Mailing Address: <br /> Business Type: Business Telephone: 3 V on o <br /> by the following named persons: <br /> FULL NAME RESIDENC <br /> C' �\\_a 13; B''t 2d k� <br /> Home Phone: —7 q 3`\— 8 2 3 <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 /> tares s required under law. <br /> Z � <br /> ature of authorized agent *Signature of authorized agent <br /> 2o - zs92S37 <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> A y In case of emergency <br /> NAME: c. TELEPHONE NUMBER: <br /> *This license will not be issued unless this certification is signed by applicant <br /> **Your social security number will be famished 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 cc ( DATE. <br /> Personally appeared before me the above-namedrl.'-C�'c.al G G L i S' 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 /> Notary Public <br /> SEAL . <br /> Margaret C. Santos �7' 2Y"ao 1 L) <br /> NOTARY PUBLIC Commission Expires: <br /> Commonwealth of Massachusetts <br /> OlAy Commission Expires Sept.24,2010 <br />