Laserfiche WebLink
BUSINESS CERTIFICATE o 9 <br /> TOWN OF MASHPEE <br /> Date: <br /> Expiration Date: <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 o-nf1 <br /> Corporation Name: (� y� Business Name/DBA:SQ,^ Q <br /> is conducted at Business Location: `r D� - � z�laos czuq <br /> Business Type: SN Q o <br /> New[ ] Renewal Commercial [ ]`Residential [ cr] Email Address: nA��1(�L1(�Q��^(lf�( f 1 <br /> Business Mailing Address: S cwn \CkQe_ D]r. umpee t Ivl� Po"If� M 'um <br /> Business Telephoner 1? �2 _Home[ ] Cell-[Q Phone: <br /> by the following named persons: <br /> Owner Name Owner Residence <br /> camhri cb e, 9r. <br /> �Aasl \V , A ou t <br /> 1 certify under Ple 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 a wired under law. <br /> D2CY ZDS'�JU J <br /> `Signatue f au ori agent "Social Security Number(Voluntary) <br /> 'This licen will not be issued unless this certification is signed by applicant or Federal Identification Number <br /> In case of emergency ( Q C <br /> NAME: <br /> _ Mi4li-) 'iaaatl TELEPHONE NUMBER: <br /> Alarm Company: N I t� <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 Massachusetts General Law,Chapter 62C,Section 49A. <br /> The Commomvealrh of Massachusetts <br /> BARNSTABLE, ss `t DATE <br /> Personally appeared before me the above-named 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 /> renewedc our years thereafl r so long as such business shall be conducted and shall lapse and a oid unless so rene d. <br /> �ned \ Notary Public <br /> Commission Expires <br /> Deborah Daml <br /> r NOTARY PUBLIC <br /> Commonwealth of Massachusetts <br /> My Commission Expires July 29,2016 <br />