Laserfiche WebLink
'- BUSINESS CERTIFICATE#09- <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE <br /> DATE v,. \n 'ate o � <br /> ExpirationDate: DCCC/71IJCY 31, 2013 <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 /> DBA \tl_rJ S N a is conducted at <br /> Business Location: <br /> Business Mailingg Address:�1 ` <br /> Business Type:\i�.a4et�� a w .,�.r.-a�+�. Business Telephone: `p��� C�.� "� \ b <br /> by the following named persons: <br /> FULL NAME RESIDENC\E <br /> Home Phone: \e\`l—`��3 -�-0 0S 16 V <br /> I certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state Yax returns and paid all state <br /> taxes as ire ndeXa , <br /> 6�7� �- <br /> rature of authorized age ignatur of authorized age t <br /> co _-� \ — —\O , `-�' ;; \g <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alarm Company: <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 Deparnnent 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 /> - <br /> isinade under the authority of Massachusetts General-Law,CliaptE-r-62C,-Section 49X. <br /> The Coatmontvealth of Massachusetts BARNSTABLE ss DATE �J-- / <br /> e , <br /> Personally appeared before me the above-named_� U h,Lj V y 0= and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with this,se ion shall be in force and effect for four years from the date of issue and shall be renewed <br /> each four years there er so long as such ess shall e conducted and shall lapse and be void unless so renewed <br /> Signed � � _ <br /> SEAL 'I ��fA'aiarlav>lic <br /> MMCPMEALTH OF M <br /> focq o&pilem"es: <br /> =25,2913 <br />