Laserfiche WebLink
` LL <br /> BUSINESS CERTIFICATE CS <br /> TOWN OF MASHPEE <br /> Date: 0 :5/0 <br /> Expiration Date: 3l <br /> In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as <br /> amended, the undersigned hereby declare(s)that a business under the title of <br /> Corporation Name: The Barn Business Name/DBA: <br /> Is conducted at Business Location: 22 Falmouth Road <br /> Business Type: Convenience Store <br /> New [ ] Renewal [ ] --Commercial [ ] Residential [ ] Email Address: <br /> Business Mailing Address: 22 Falmouth Road Mashpee MA S`02649 <br /> Business Telephone: Home [ ] Cell [ ] Phone: Cso99( T7-7-35-93)J� <br /> by the following named persons: C 12LL C.SD�j�C3 60 — �74-[) <br /> Owner Name Owner Residence <br /> Mohammad Shafique N/A <br /> ZL <br /> hJASHQ�� /rl/¢Do26�j` g <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 <br /> all state taxes a/ s regyyr law. <br /> *Sighature of authorized agent **Social Security Number(Voluntary) <br /> *This license will not be issued unless this certification is signed by applicant or Federal Identification Number <br /> In case of emergency n ? <br /> NAME: s� 5��� A /K�� TELEPHONE NUMBER: SO 9 J 1 i9Sq 9 <br /> x Alarm Company: <br /> "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax <br /> filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or <br /> revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth of Massachusetts <br /> ZO /3 <br /> BARNSTABLE, ss DATE 5 <br /> Personally appeared before me the above-named 1yhiW1j4j0 S4 and made oath that the foregoing <br /> statement is true. <br /> A certificate issued in accordance with this section shall be id'force and effect for four <br /> w ars from the date of issue and shall be <br /> renewed eec/h�F®our ars t ereafter s ong as such business shall be conducted and shall lapse and Munless so re <br /> �igned d/' _ Notary Public <br /> _ Commiss' Expires <br /> WNOTARY PUBLIC <br /> Commtumeatth of Masliachusetts <br /> fly Commission Euros Jury 29.2016 <br />