Laserfiche WebLink
BUSINESS CERTIFICATE <br /> TOWN OF MASHPEE -PBn���7 <br /> Date: 9 / <br /> Expiration Date: 3/ / <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: Business Name/DBA: <br /> is conducted at Business Location: 32 Christopher Lane <br /> Business Type: Child Care <br /> New [ ] Renewal Dt�] --Commercial [ ] Residential [ ] Email Address: TilS <�c�SrCSzat� -�c/atio0.coin <br /> Business Mailing Address: Business Location: 32 Christopher Lane l/ V <br /> Business Telephone-508--53945-±0 Home k] Cell [ ] Phone <br /> 508-53q-6f8o <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Sharon Dupont 32 Christopher Lane <br /> 1 certify under the penalties of perjury that 1, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> all state taxes as re wired under law. <br /> *Signa ure of auth ized 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 <br /> NAME: TELEPHONE NUMBER: <br /> i <br /> i <br /> Alarm Company: <br /> i <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 subiect to license suspension or <br /> revocation. This request is made under the authority of Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commonwealth ojMussuchusens > <br /> BARNSTABLE, ss DAT l /p <br /> J <br /> Personally appeared before me the above-named �""r � and made oath that the foregoing <br /> statement is 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 <br /> renewed each four years they after so long as such business shall be conducted and shall lapse an void unless so renewed. <br /> Signed Notary Publi <br /> C s ' x <br /> JOSEPH L.MA22UCCHELLI,JR <br /> Notary Public <br /> COMMONWEALTH of►MSSACKUK"f <br /> My Camioaion Expires <br /> Odd* 2019 <br />