Laserfiche WebLink
BUSINESS CERTIFICATEC�b/4 !/ 3 <br /> TOWN OF MASHPEE ��`` � // <br /> • Date: �/� M.be.' /O <br /> Expiration Date: �/)��6ey o�/� <br /> r i' <br /> In conformity with the provisions of Chapter 110, §5 of the Massachusetts General Laws, as amended, the <br /> undersigned hereby declare(s) that a business under the title of <br /> Business Name/DBA: Mashpee Chiropractic Corporation Name: <br /> is conducted at Business Location: 759 Falmouth Road, #3 Certificate No. 2009-082 <br /> Business Type: Chiropractic <br /> New [ ] Renewal 0 Commercial [] Residential [ ] Email Address: 140&kefB if s+ PY C+M Jn L b4"'t La"A <br /> -Kq Frxl wto'tr . 2-at- 0-3 <br /> Business Mailing Address: P9-Bex+3•Cr7 Mashpee, MA 02649 <br /> Business Telephone: 508-477-8242 Home 0 Cell [ ] Phone: 508-477-5120 <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> Robert Lakatos 46 Polaris Drive Mashpee, MA 02649 <br /> '0certify under the penalties of perjury that I, to the best of my knowledge and belief, have filed all state tax returns and paid <br /> ll state taxes as required under law. <br /> 'Signature of authorized agent "Social Security Number <br /> "This license will not be issued unless this certification is signed by applicant or Federal Identification Number <br /> (Required) <br /> In case of emergency <br /> NAME: 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 <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 Chapter 62C,§49A Massachusetts General Laws <br /> The Commonwealth of Massachusetts <br /> BARNSTABLE: ss t7 t DATE <br /> Personally appeared before me the above-named.-T rT E and made oath that the foregoing <br /> statement is true. <br /> A certificate iscyFffin ace dnce with this section shall be in force and effect for four years from the date of issue and shall be <br /> renewed each four ye r� eerea long as such business shall be conducted and shall lapse and be y,6V unlesssoreennewe/r'7I�,{,�, . <br /> igned Notary Public <br /> Deborah DaMl <br /> NOTARY PUBLIC'Commission Expires <br /> Commonweafth otiMs y Zg 018 <br /> My ComtnlSS10 Exp <br />