2013 - Laserfiche WebLink

Home Browse Search

BUSINESS CERTIFICATE D-d/3- 6 </7 TOWN OF MASHPEE / X Date: • Expiration Date: / In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the undersigned hereby declare(s)that a business under the title of ` _(J Corporation Name: Business Naame�/DBBA: W O is conducted at Business Location: �� 46 �.J\ ` v t I'o /` °L S Business Type: �� A N 2 //v J4 `r �i o� New [/] Renewal [ ] --Commercial [ ] Residential Email Address: J b 0 �AIO— ' Business Mailing Address: 230 Z Business Telephone:!2� L—M4 Home [ ] Cell [ ] Phone: by the following named persons: Owner Name Owner Residence RC, lA, 171�� wA_y 1>_51e 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 taxes as required under law. 7 220 `1 *Signature uthorized agent **Social Security Number(Voluntary) *This license i not be issued unless this certification is signed by applicant or,Federal Identification Number In case of emergency NAME: TELEPHONE NUMBER: Alarm Company: "Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax 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 authorityof Massachusetts General Law,Chapter 62C,Section 49A. sp The Commonwealth of Massachusetts BARNSTABLE, ss DATE Z /-3 Personally appeared before me the above-named V�1 � -� and made oath that the foregoing statement is true. 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 each four years there er so long a such business shall be conducted and shall lapse and be void unless so renewed. •Signed ` Notary Public JOSEPH L MAM=4ELU,J Commissio s Notmy Public SAplt18 My commission FapireM pctohrt 25.201 .