Laserfiche WebLink
BUSINESS CERTIFICATE�Z <br /> TOWN OF MASHPEE yJ <br /> • Date: ,,,&C A // QO d I/ <br /> Expiration Date: ?'r'b .2/, C901r <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: Coy <br /> is conducted at Business Location: <br /> Business Type: (I cws U f 7#pjCtI/ <br /> New[A Renewal [ ]—Commercial [ ]Residential [ ] EyI�mmail Address: <br /> rl / s08® Vie! (m-/V ( <br /> /—/ <br /> Business Mailing Address: 300 Yc'"— /C !�d UZZI l�C —/ Z/�E>L��C � #—02(0'1-q <br /> Business Telephone:566,5:3q.613 Home[ ]Cell [ ] Phone: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> 1�57F /U • UJB V sob 1r*j -V7-ff 66, 12C-,6swe��- <br /> Zf <br /> 1 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 staW taxes as requ' der law. <br /> *Signature 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 <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 sublect 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 /> BARNSTABLE, ss / �1 DATELLCG��a/S/ <br /> Personally appeared before me the above-named _f/eS k'.. K C..U/ittn and made oath that the foregoing <br /> statement is true. <br /> A certificate issued ' accordance with this section shall be in force and effect for four years from the date of issue and shall be <br /> rencwedeaphiburycarsth9ocirsol ig w such business shall be conducted and shall lapse and be void unless so rene <br /> Signe Notary Public <br /> • Commission Expires a'y—a4D 1 <br /> Notary Public <br /> Margaret C.Santos <br /> Comitormealth of Massachusetts <br /> My Commission Expires on Sept.22,2D17 <br /> 'vV <br /> .1, V v`~ <br />