Laserfiche WebLink
ti <br /> BUSINESS CERTIFICATE# <br /> • THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE Q <br /> • DATE <br /> Expiration Date: <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 /> T f-f O S G O��nc• DBA 0� 1"P-5 a'Q' f S�� 1 Ur; O� is conducted at <br /> Business Location: g �n � ��75 1 ��r'y��/ / '1 �'SN �{"-�'e,'/�� /• 'r/ ��' by l <br /> Business Mailing Address: <br /> II CiO��' l./� �] <br /> Business Type: L() �o ('2 S�L)'�- Business Telephone: g' 0-0 y J — / O <br /> Home Phone: <br /> by the following named persons: <br /> FULLN E REQ EN �Q <br /> PP oi sha=g=_z, A �a � y� <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 /> . taxes as required under law. <br /> *Signature of/of authorized agent *Signature of authorized agent <br /> y- --h 5--4 y 15-- D <br /> **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> In case of emergency <br /> NAME: TELEPHONE NUMBER: <br /> Alann 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 subiecl 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 Massachusettsa(O ^ <br /> „to <br /> BARNSTABLE ss /� DATE o� <br /> Personally appeared before me the above-named t (IS Lt T&P A and made oath that the foregoing statement is <br /> true. <br /> A certificate issued in accordance with thissecuon 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 bus'ness s 511 6 conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> 0� � <br /> ebWah D otary Public <br /> • SEAL e� cornNOTAW�Pu��B..U�,C.,_�� <br /> IIfyC�Ip 4062 Q Commission Expires: <br />