Laserfiche WebLink
BUSINESS CERTIFICATE#l -�a <br /> THE COMMONWEALTH"MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> • DATE 7 — 6 S <br /> Expiration Date: December 31, 200f <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 /> t i( AS/4<«(I 1 yL ff DBA_r(l((�i 4;,Z C145-51C is conducted at <br /> Business Location: �� ( rA 11,1r v v r"k /LtP; >y iv VC 1 1 r MASAp �,e MA 02(P <br /> Business Mailing Address: u K h <br /> yi <br /> Business Type:Kv 1,g4 t✓eeX �t i. Business Telephone: �7-6 8 V 77" PL 7 7 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> N tL2e ( ti r .PSfi 9 � o� M� fns yd <br /> 0,/ 5 C,Vkk, rtv o &/, /V, F,alf,,,74 62-0-1 <br /> Home Phone: 'l)$- �,q F.1 (� <br /> Wsfy 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 /> as required under law. <br /> ( '� , Q, / <br /> *Signature of individual By: Corporate Officer <br /> 017 - 3q -F '-3 2- <br /> "Social <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <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 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 (^\ DATE 0,31G 71,0 <br /> Personally appeared before me the below named V�^n .•. 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 /> h,1AR111 s(791_7 Notary Public <br /> SEAL .. Noma Public I o,��4 3 aQU/ <br /> ., -.• - - -•- Commom«aldi of ytassachusetts ommission Expires: /"1 P rJ <br /> M_v Commission Gxpires <br /> March <br /> 1.2006 <br />