Laserfiche WebLink
BUSINESS CERTIFICATE <br /> V THE COMMONWEALTH OF MASSACHUSETTS <br /> TOWN OF MASHPEE /¢y� <br /> • DATE $ <br /> r <br /> Expiration Date: f 3/ <br /> In conformity with the provisions of Chapter 110, §5 ofthe Massachusetts General Laws,as amended,the undersigned hereby declare(s) <br /> that a business under the title o �( A <br /> Business Name/DBA: �n Ar / V Q'� Corporation <br /> Name: <br /> LIrC <br /> is conducted at Business Locations: a qr&,,// /t GC4 IGT ��(D 1 Commercial✓/ Residential_ <br /> Business Mailing Address: <br /> Business Type- L/�G 1 1 I� Business Telephone: <br /> New [ Renewal ] Home Phone: <br /> ^ r,� <br /> Email Address: lawk e yl� �yVtct�l r � <br /> by the following named persons: <br /> Owpr,Name Owner Residence <br /> Second Owner Name Second Owner Address <br /> 0ify under the penalties of perju -to-the best of my knowledge and belief, have filed all state tax returns and paid all state <br /> taxes as required under I <br /> 6og 6 � coy( <br /> Signature (Lwiaicrrized agent "Social Security Number or <br /> or Federal Identification Number(Required) <br /> *This license will not be issued unless this certification is signed by applicant <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 filing or tax <br /> payment obligations. Licensees who fail to correct[heir non-filing or delinquency will be subject to license suspension or revocation. This request <br /> is made under the authority of Chapter 62C, §49A of Massachusetts General Laws. <br /> The Commonwealth ofMassachusetr <br /> BARNSTABLE ss / DATE b <br /> Personally appeared before me the above-named and made oath that the foregoing statement is true. <br /> A certificate issued in accordance with tahLisaection shall be in force and effect for four years from the date of issue and shall be renewed each <br /> four years thereafter so long as such bu ' ess-sha If be conducted and shall lapse and be void unless so renewed. <br /> �} FTL EW,JR. <br /> SEAL NOTARY LIC <br /> MpWW .tplFaP6W16,2020 <br />