Laserfiche WebLink
M � <br /> k <br /> BUSINESS CERTIFICATE#07 F-!2 <br /> 1 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE `` __ I <br /> DATE ,--N C?ACGC c��S` o 00(0 <br /> Expiration Date: December 31, 2011 <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 /> y�P CSC x h o✓ DBA ��yjd 5 V rIt��i ct >3nN is conducted at <br /> Business Location: (1'61 _T�_Gll i4ntl��r 5 u"Ir Atli <br /> Business Mailing Address: '5 -e, dam— ` <br /> Business Type: 0-0%yP, Business Telephone: iso�1 ��/7'2 <br /> by the following named persons: <br /> FULL NAME RESIDENCE <br /> LLL <br /> ; Gz6SIio w Ad, b)a�ZT' d,4 0,2 3(o <br /> Home Phone: 7, S ;z,5 <br /> I certify under the penalties of perjury that I, to the best of my knpw&Zlgzsand belief, have filed all st to tax returns and paid all state <br /> Vess requ' ed under 2a ,, <br /> *Signature of authorized agent *Signature of authorize agent <br /> 0q- 3aSyl? <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: t�Qm�l bh �/ �Lh� TELEPHONE NUMBER: <br /> ry Yd� GGZ "yGpC% <br /> Alarm Company: 1 ��rfGvt>ZiH�clr-S '(Z7'C72a.�di <br /> *This license will not be issued unless this certification is signed by applicant <br /> 3453 <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 -1 J DATE (I I U W <br /> Personally appeared before me the above-named ( U IYI Uri G( PICylar6t;Jr•and made oath that the foregoing statement is <br /> true. <br /> A cer8�p.t,4qHkH(r m?,,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 ye V69 (bj /x$/such business shall be conducted and shall lapse and be void unless so renewed. <br /> tied ` \,O��,t5510Np 010s <br /> ON.Ti 2 <br /> • C' hlotary Public <br /> i w P <br /> OF Jo eii <br /> 'IP "�\S�`` Commission Expires: <br />