Laserfiche WebLink
BUSINPSS cERTIFICATL N 09 " C�3 <br /> 7711,' COMMONFVLALT71 OF n9AssACIIUSETYS <br /> TOH1A'OF n1As1--1i'1.L <br /> DATE <br /> Expiration Date: DeceinbeT 31, 2013. - <br /> In conformity with the provisions of Chaplet one hundred and ten, Section live of the General Laws, as amended, the - <br /> undersigned hereby declare(s) <br /> pthat a business under file title of ✓,�/�,, l �1 <br /> `(�o>t�� 0 6614��yL DBA �t` ��fO�K v is conducted at <br /> Business Location: flu <br /> Business Mailing Address: 'Q n <br /> Business Type L t"U7{'ii/� Business Telephone: Soo, o 7® 6 tl O 7 <br /> I <br /> by the following named persons: <br /> rri4 D FULL P MLI /?q <br /> Home Phone: bel <br /> I certify under the penalties of petjtuy that I, to the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> 0ign <br /> as required under law. <br /> atrlre of authorized agent *Signahue of authorized agent <br /> **Social Security Number(Vohmtaiy) - <br /> or Federal Identification Number - <br /> t� In case of emergency /� �/ j} <br /> NAME:. 9IfI G t� TELEPHONENUMBER:"6y Y99Ot v <br /> Alarm Company: <br /> *This license will not be issued unless this certificationis signed by applicant - <br /> "YOUl social security number will be furnished to'thc Massachusetts Department of Revenue to d'etermire whether you have inet 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 is made under the authority of Massachusetts General Law,Chapter 62C,.Section 49A. <br /> The Cauuronivealth of Missndlusetts hh__ <br /> BAI2NS7'ABLE ss DATE <br /> Personally appeared before me the above-named 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 til/e/rye/y,{(fe�/r so long as s c i mess shall be conducted and shall lapse and be void unless so renewed. <br /> Si�ncd <br /> A Deborah F. Dami Notary P. he <br /> NOTARYPUBLIC <br /> SEAL Commonwealth of Massachusetts <br /> My Commission Expires July 24,2009 commission Expires: <br />