Laserfiche WebLink
BUSINESS CERTIFICATE# 10- 0-7 3 <br /> THE COMMONWEALTH OF MASSACHUSETTS <br /> • <br /> TO PVN OF NIASHPEE <br /> DATE �I/ q/�� <br /> Expiration Date: 3� <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 /> &K Qjr DBA �_B � ft�riseS is conducted at <br /> Business Location: U 3 <br /> Business tMaiiing Address: P-C 0 k I '� J / <br /> Business Type: � Dvu4i�t nQGe o F Business Telephone: <br /> Home Phone: 1.713 <br /> by the following named persons: ' <br /> FULL NAME RESIDENCE <br /> I p tyre i 1 &*L Pe d 1'tl & 3 �, e r a.8 S <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 /> as required under law. <br /> Sxes �> <br />� *Signature o art <br /> borized agen `Signature of authorized agent <br /> i <br /> "Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> Q n In case of emergency <br /> NAME: &4Q , rC I�SGI TELEPHONE NUMBER: JyS-77(—EYL y <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 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 ojAtnssachusetts <br /> BARNSTrIBLE ss DATE <br /> Personally appeared before me the above-named LL ✓Z Q 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 cars thereafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • I,JR <br /> Nota' <br /> t p,ihlic�: . <br /> SEAL �CAYYOMNEALTH OF <br /> es: <br />