Laserfiche WebLink
f�• BUSINESS CERTIFICATE# odd/ <br /> THF COMMONWEALTH OF iWASSACHUSETTS <br /> TONY OF NJASHPEE <br /> • DATE /n /d /O n <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) <br /> that a bb/1uusiness�under the title of^� <br /> Business Name/DBA:(_e.02.(;4Xl4WI/012/CCo po/tion Name: is conducted at <br /> Business Location: s-S-S AOAlJ r/R[',_z-ml�.IH�F`r�1/19 p <br /> Business Mailing Address: <br /> Business Type: ri _"� "7p_a /(-®YISU /!9 Business Telephone: c!r-f <br /> Home Phone: ,fOr7 nV9l 7 Email Address: /'Odea'or�!'1ThSU(�� 027CL/ <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> !n PVA G2 • TB/� /1"So^� Ss ,�o r.(� G/tPC�/ l�/9s�/�/�` z/71 <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 a eq tired under law. <br /> ignantre of authorized agent **Social Security Number(Voluntary) <br /> or Federal Identification Number <br /> *This license will not be issued unless this certification is signed by applicant <br /> In case of emergency <br /> NA�4E:/Tis/Qx 1�6i7sOh TELEPHONE NUMBER: <br /> Alarm Company: <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 subiect to license suspension or revocation. This request <br /> is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth ofAlassachusetts _ / 1 <br /> B:UL\S7•A.BLE ss - DATE <br /> Personally appeared before me the above-named 1,Ag/l+ IN _1l�LS 17-Co A"/ and made oath that the foregoing statement is <br /> v <br /> [fUC. <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 t eafter so long as such business shall be conducted and shall lapse and be void unless so renewed. <br /> Signed <br /> • <br /> NotaryPublic <br /> -_ <br /> SEAL <br /> -19 <br /> CoridwisptablExpires: <br /> COMMONWEALTH OF MASSACI LUM <br /> MY <br /> - Otio0R.23,201 <br />